☰ INDEX
Cardiothoracic_Vascular_Surgery-Arterial_Disorders
Cardiothoracic_Vascular_Surgery-Lymphatic_System
Cardiothoracic_Vascular_Surgery-Previous_Year_Questions
Cardiothoracic_Vascular_Surgery-Thorax_and_Mediastinum
Cardiothoracic_Vascular_Surgery-Venous_Disorders
Clinical_Essentials-Previous_Year_Questions
Endocrine_Surgery-Breast-I
Endocrine_Surgery-Breast-II
Endocrine_Surgery-Parathyroid_and_Adrenal_Glands
Endocrine_Surgery-Previous_Year_Questions
Endocrine_Surgery-Thyroid-I
Endocrine_Surgery-Thyroid-II
Gastrointestinal_Surgery-Appendix
Gastrointestinal_Surgery-Esophagus
Gastrointestinal_Surgery-Hernia
Gastrointestinal_Surgery-Ileostomy__Colostomy__and_IBD
Gastrointestinal_Surgery-Intestinal_Obstruction
Gastrointestinal_Surgery-Large_Intestine-I
Gastrointestinal_Surgery-Large_Intestine-II
Gastrointestinal_Surgery-Previous_Year_Questions
Gastrointestinal_Surgery-Previous_Year_Questions_1
Gastrointestinal_Surgery-Rectum_and_Anal_Canal
Gastrointestinal_Surgery-Small_Intestine
Gastrointestinal_Surgery-Spleen
Gastrointestinal_Surgery-Stomach-I
General-Previous_Year_Questions
General_Surgery-Previous_Year_Questions
Head_And_Neck-Neck__Facial_Injuries___Abnormalities
Head_And_Neck-Oral_Cavity
Head_And_Neck-Previous_Year_Questions
Head_And_Neck-Salivary_Glands
Hepatobiliary_Pancreatic_Surgery-Bile_Duct
Hepatobiliary_Pancreatic_Surgery-Gall_bladder
Hepatobiliary_Pancreatic_Surgery-Liver_Tumors
Hepatobiliary_Pancreatic_Surgery-Pancreatic_Tumors
Hepatobiliary_Pancreatic_Surgery-Portal_Hypertension
Hepatobiliary_Pancreatic_Surgery-Previous_Year_Questions
High_Yield_Topics-Previous_Year_Questions
Image_Based_Questions-Previous_Year_Questions
Instruments-Previous_Year_Questions
Miscellaneous-Abdominal_Trauma
Miscellaneous-General_Surgery__Robotic__Laparoscopic__and_Bariatric_Surgeries
Miscellaneous-Injuries_to_the_Head__Neck__and_Thorax
Miscellaneous-Instruments
Miscellaneous-Nutrition__Sutures__and_Anastomosis
Miscellaneous-Previous_Year_Questions
Miscellaneous-Transplantation
Miscellaneous-Trauma_ATLS_Protocol
Miscellaneous-_Pediatric_Surgery
Miscellaneous-_Shock
Miscellaneous-_Tubes__Catheters__and_Drains
Neurosurgery-CNS_Tumors
Neurosurgery-Cerebrovascular_Diseases
Neurosurgery-Previous_Year_Questions
Oncology-Oncology
Oncology-Previous_Year_Questions
Others-Previous_Year_Questions
Plastic_Surgery-Burns
Plastic_Surgery-Previous_Year_Questions
Plastic_Surgery-Wound_Healing
Plastic_Surgery-_Plastic_Surgery_and_Skin_Lesions
Urology-Previous_Year_Questions
Urology-Prostate_and_Seminal_Vesicles
Urology-Renal_Stones__Infections_Disorders_of_Kidney__Hydronephrosis__and_Genitourinary_Tuberculosis
Urology-Testis_and_Scrotum
Urology-Urethra_and_Penis
Urology-Urinary_Bladder
Urology-_Renal_Tumors_and_Renal_Congenital_Abnormalities
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 62-year-old male patient is having complaints of loss of vision in the form of a curtain coming down in front of the right eye. He has a history of 2 episodes of strokes, after which he has left-sided sensory and motor loss limited to the face and neck. Which of the following blood vessels might be stenosed in this case?", "options": [{"label": "A", "text": "Left vertebral artery", "correct": false}, {"label": "B", "text": "Carotid artery", "correct": true}, {"label": "C", "text": "First part of the left subclavian artery", "correct": false}, {"label": "D", "text": "Superior mesenteric vein", "correct": false}], "correct_answer": "B. Carotid artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AHOEhVPxV9AqP2KWw5RV1748756585.mp3", "video": ""}, {"text": "A 67-year-old male was having complaints of sudden onset of severe chest pain, which was radiating to his back, and suddenly, he went unconscious. He was chronically hypertensive, a drug defaulter, and was having weakness, dizziness and dyspnea for 1 day. His current BP is 90/50 mm Hg, and his Heart Rate is 140 bpm. What is the best investigation of choice in this condition?", "options": [{"label": "A", "text": "CT Angiography", "correct": false}, {"label": "B", "text": "Aortography", "correct": false}, {"label": "C", "text": "TransEsophageal Echocardiography", "correct": true}, {"label": "D", "text": "Chest x-ray", "correct": false}], "correct_answer": "C. TransEsophageal Echocardiography", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r4VCQ0Fdb3nIgwDNGtRq1740044218.png", "https://image.prepladder.com/content/jUBLM8wuwR7dhJmCVcJe1740044256.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7gkAi2Gkcvi6CRWwvvDD1745395651.mp3", "video": ""}, {"text": "Which of the following signs is seen in Arteriovenous fistula?", "options": [{"label": "A", "text": "Murphy’s sign", "correct": false}, {"label": "B", "text": "Brudzinski’s sign", "correct": false}, {"label": "C", "text": "Hegar’s sign", "correct": false}, {"label": "D", "text": "Nicoladoni’s sign", "correct": true}], "correct_answer": "D. Nicoladoni’s sign", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zxo2QliQTBz1jzTfy3091746107355.mp3", "video": ""}, {"text": "A 35-year-old female experiences numbness and tingling in her right arm, worsened by arm elevation. During examination, she abducts her arms to 90° with external rotation, flexes her elbows to 90°, and opens and closes her hands for 3 minutes, which reproduces her symptoms. Which test was most likely performed?", "options": [{"label": "A", "text": "Adson's Test", "correct": false}, {"label": "B", "text": "Roos Test", "correct": true}, {"label": "C", "text": "Wright's Test", "correct": false}, {"label": "D", "text": "Elvey Test", "correct": false}], "correct_answer": "B. Roos Test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jVEo6OaUanciPU7BeZvL1740043285.png", "https://image.prepladder.com/content/2g8Fbtz782b3qeYhO4ud1740043532.png", "https://image.prepladder.com/content/50kEHxpukujt9fDYFZTX1740043360.png", "https://image.prepladder.com/content/TaOCdZ1699xKaccMJR6R1740043428.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maneuver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adson's Test </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arm abducted 30° and maximally extended. Patient extends neck, turns head toward the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> side, and inhales deeply.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrease or absence of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated Arm Stress Test (EAST)</strong> / <strong>Roos Test </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arms in \"surrender\" position (abducted 90°, external rotation, elbows flexed 90°).</p>\n<p>The patient slowly opens and closes hands for 3 minutes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, paresthesia, heaviness, or weakness precipitated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Upper Limb Tension Test (ULTT)</strong> / <strong>Elvey Test </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Position 1:</strong> Arms abducted 90°, elbows flexed.</li>\n<li><strong>Position 2:</strong> Active <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of wrists.</li>\n<li><strong>Position 3:</strong> Tilt head (ear to shoulder) in both directions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms in the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> arm (Position 1 &amp; 2); <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> symptoms in Position 3.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maneuver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adson's Test </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arm abducted 30° and maximally extended. Patient extends neck, turns head toward the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> side, and inhales deeply.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrease or absence of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated Arm Stress Test (EAST)</strong> / <strong>Roos Test </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arms in \"surrender\" position (abducted 90°, external rotation, elbows flexed 90°).</p>\n<p>The patient slowly opens and closes hands for 3 minutes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, paresthesia, heaviness, or weakness precipitated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Upper Limb Tension Test (ULTT)</strong> / <strong>Elvey Test </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Position 1:</strong> Arms abducted 90°, elbows flexed.</li>\n<li><strong>Position 2:</strong> Active <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of wrists.</li>\n<li><strong>Position 3:</strong> Tilt head (ear to shoulder) in both directions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms in the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> arm (Position 1 &amp; 2); <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> symptoms in Position 3.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old competitive swimmer presents with progressive weakness and tingling in his right hand. On examination, there is wasting of the small muscles of the hand and sensory loss in the medial side of the hand and forearm. Which of the following nerves is most likely compressed in this patient?", "options": [{"label": "A", "text": "Median nerve (C5-T1", "correct": false}, {"label": "B", "text": "Ulnar nerve (C8-T1)", "correct": true}, {"label": "C", "text": "Radial nerve (C5-T1)", "correct": false}, {"label": "D", "text": "Axillary nerve (C5-C6)", "correct": false}], "correct_answer": "B. Ulnar nerve (C8-T1)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boundaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Upper:</strong> Collarbone (Clavicle)</li>\n<li><strong>Lower:</strong> First Rib</li>\n<li><strong>Anterior:</strong> <span class=\"customMeta\" data-dictid=\"8375432547169277719800ec10e35c\">Scalenus</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Muscle</li>\n<li><strong>Posterior:</strong> <span class=\"customMeta\" data-dictid=\"8375432547169277719800ec10e35c\">Scalenus</span> <span class=\"customMeta\" data-dictid=\"00574839f41692777192453025ab4a\">Medius</span> Muscle</li>\n<li><strong>Medial:</strong> <span class=\"customMeta\" data-dictid=\"c9b658143016927771985deca1dbb9\">Scalene</span> <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> (formed by the <span class=\"customMeta\" data-dictid=\"8375432547169277719800ec10e35c\">Scalenus</span> Anterior, <span class=\"customMeta\" data-dictid=\"8375432547169277719800ec10e35c\">Scalenus</span> Medius, and First Rib)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predisposing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical Rib, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Trauma), Pancoast Tumor, Osteoarthritis, Long <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">Transverse</span> Process of C7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Neurogenic TOS:</strong> Pain, numbness, and <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> due to nerve compression</li>\n<li><strong>Arterial TOS:</strong> Pain, coldness, and paleness due to impaired <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> flow</li>\n<li><strong>Venous TOS:</strong> Swelling, pain, and discolouration due to impaired <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VWQcFIn82yn391Iv16N31748754109.mp3", "video": ""}, {"text": "Which of the following is the most preferred vascular graft for CABG?", "options": [{"label": "A", "text": "Long saphenous vein", "correct": false}, {"label": "B", "text": "Dacron", "correct": false}, {"label": "C", "text": "Polyurethane", "correct": false}, {"label": "D", "text": "Left Internal Mammary Artery", "correct": true}], "correct_answer": "D. Left Internal Mammary Artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/53u71lSdHxk5hvzyoVL81740059908.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SgD80fCYBVPRBuqnH21I1748756471.mp3", "video": ""}, {"text": "A 48-year-old male presents with retrosternal chest pain, which was radiation to the left arm and shoulder. He has a previous history of acute myocardial infarction. CABG was advised, but the patient is insisting on using synthetic graft and wants to know more about it. Which of the following is the most preferred synthetic vascular graft for CABG?", "options": [{"label": "A", "text": "Polyurethane", "correct": false}, {"label": "B", "text": "ePTFE", "correct": false}, {"label": "C", "text": "Dacron", "correct": true}, {"label": "D", "text": "Long saphenous vein", "correct": false}], "correct_answer": "C. Dacron", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3wtVzHUrvC2Q95GhZEh51740059849.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Si8gKlN0jYvlkRlfBRh01748756369.mp3", "video": ""}, {"text": "Based on the Stanford classification, which type of aortic dissection is shown below?", "options": [{"label": "A", "text": "Type A", "correct": true}, {"label": "B", "text": "Type B", "correct": false}, {"label": "C", "text": "Type C", "correct": false}, {"label": "D", "text": "Type D", "correct": false}], "correct_answer": "A. Type A", "question_images": ["https://image.prepladder.com/content/bTvKcpnI1S1whdsyErIr1740044336.png"], "explanation_images": ["https://image.prepladder.com/content/cj0JG2zSkirrfH7Q7M2r1740044362.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DeBakey Classification</strong></p>\n<p>(Based on the pattern of dissection)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> are involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stanford <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n<p>(Based on whether the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved in aortic dissection)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> or both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved. <strong>(Option A)</strong></p>\n<p>(It includes both <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> and <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">Type II</span> of DeBakey’s classification)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved. <strong>(Option B)</strong></p>\n<p>(It includes <span class=\"customMeta\" data-dictid=\"adcadb82091692777201d084ed114c\">Type III</span> of DeBakey’s classification)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qIIaxmr4LwkL7osUGUF61748756228.mp3", "video": ""}, {"text": "A 72-year-old male with a history of hypertension and smoking presents with back pain, and imaging shows a thoracoabdominal aortic aneurysm starting at the sixth intercostal space and extending to just above the renal arteries. According to the Crawford classification, which type does this aneurysm correspond to?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type V", "correct": true}], "correct_answer": "D. Type V", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cC0uoh8rEUqM5wHaAf1Q1740044155.png", "https://image.prepladder.com/content/WmQp5mAa6OpyJLAqmHBf1740044072.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:579px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involvement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descending <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> to above <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> arteries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descending <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> to below <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> arteries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>From the sixth <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space to below <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> arteries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The entire <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> from the twelfth <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space to the aortic bifurcation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portion of the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> below the sixth <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space to above <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> arteries.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4W7S2Z2RPjqe5P8WQ4QZ1747830939.mp3", "video": ""}, {"text": "A 65-year-old male with a history of hypertension and smoking presents with an abdominal aortic aneurysm measuring 6.0 cm in diameter, detected during routine surveillance. Which of the following is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Regular ultrasound surveillance every 6 months", "correct": false}, {"label": "B", "text": "Begin beta-blocker therapy", "correct": false}, {"label": "C", "text": "Endovascular aneurysm repair", "correct": true}, {"label": "D", "text": "Lifestyle modifications and smoking cessation", "correct": false}], "correct_answer": "C. Endovascular aneurysm repair", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Small AAAs (3.0–3.9 cm):</strong> Monitor every 2–3 years using ultrasound.</li>\n<li><strong>Medium AAAs (4.0–5.4 cm):</strong> Monitor every 6–12 months with ultrasound.</li>\n<li><strong>Large AAAs (≥5.5 cm): </strong>Surgical intervention recommended; if not, frequent <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> and clinical review.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factor Modification</strong>:</p>\n<ul>\n<li>Smoking Cessation</li>\n<li>Blood Pressure Control</li>\n<li>Cholesterol Management: Statins recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I<strong>ndications for Surgery:</strong></p>\n<ul>\n<li><strong>Aneurysm <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">Diameter</span> ≥ 5.5 cm</strong> (High risk of rupture)</li>\n<li><strong>Rapid Growth: &gt;0.5 cm</strong> increase in six months.</li>\n<li><strong>Symptomatic AAAs</strong>: Consider surgery.</li>\n</ul>\n<p><strong>Surgical Options</strong>:</p>\n<ul>\n<li><strong>Open <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Repair:</strong> Using a Dacron <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> which is durable and has higher morbidity.</li>\n<li><strong>Endovascular <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> Repair (EVAR):</strong> Less invasive, requires long-term surveillance for complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/96HcnGcSbVDQb1hLdYjI1748756062.mp3", "video": ""}, {"text": "A 45-year-old male with a history of bacterial endocarditis presents with sudden onset of severe headache, nausea, and vomiting. A CT scan of the head is shown below. Which of the following is the most likely cause of the haemorrhage in this patient?", "options": [{"label": "A", "text": "Ruptured berry aneurysm", "correct": false}, {"label": "B", "text": "Traumatic brain injury", "correct": false}, {"label": "C", "text": "Hypertensive intracerebral haemorrhage", "correct": false}, {"label": "D", "text": "Ruptured mycotic aneurysm", "correct": true}], "correct_answer": "D. Ruptured mycotic aneurysm", "question_images": ["https://image.prepladder.com/content/EEIWsVGl5eeEwvkNBS6G1740043926.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/c5Yz6tmXHMmIf5vTpLo51748755656.mp3", "video": ""}, {"text": "A 58-year-old male presents with a pulsatile mass in the right groin following recent arterial catheterisation. Doppler ultrasound reveals an aneurysm. Which characteristic best describes this type of aneurysm?", "options": [{"label": "A", "text": "Involves all three arterial wall layers", "correct": false}, {"label": "B", "text": "Fusiform dilation of the artery.", "correct": false}, {"label": "C", "text": "Wall composed of fibrous tissue only", "correct": true}, {"label": "D", "text": "Commonly caused by atherosclerosis", "correct": false}], "correct_answer": "C. Wall composed of fibrous tissue only", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EnrNbL7XYhxq2E7NShfz1740043832.png", "https://image.prepladder.com/content/uppnRZ6isxehhXNEHPJd1740043855.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>False (Pseudoaneurysm)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves all three layers of the arterial wall.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves only a layer of <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue outside the vessel. (Option A ruled out)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wall Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intima, media, and <span class=\"customMeta\" data-dictid=\"a438935bda1692777180dfaf993677\">adventitia</span> are involved.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue surrounds the breach.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fusiform or saccular.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically spherical or ovoid.(Option B ruled out)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atherosclerosis, genetic conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma, surgery, or arterial puncture.(Option D ruled out)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> until complications arise.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often presents with a <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass or pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large arteries (e.g., aorta, iliac).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peripheral arteries (e.g., femoral, popliteal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detected by ultrasound, CT, and MRI.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detected by <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical repair or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> techniques.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repair or <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> methods (e.g., <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> injection).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fusiform Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilation affects the entire <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the vessel</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal aorta, iliac</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atherosclerosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Saccular Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilation affects only part of the vessel circumference</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebral arteries, aortic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atherosclerosis, infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycotic Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by infection (Bacterial)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually cerebral or aortic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endocarditis, septicemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Root Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilates the aortic root, leading to aortic regurgitation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aortic root</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connective tissue disorders, syphilis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Popliteal Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> aneurysm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behind the knee</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atherosclerosis, embolisation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Femoral Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be true or false, often related to surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Groin area</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Post-surgical complication</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iliac Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often coexists with AAA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iliac arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal Aortic Aneurysms (AAA)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sS4efNYsQdvGfP2StMS81748754892.mp3", "video": ""}, {"text": "A 65-year-old male with a history of atrial fibrillation presents to the emergency department with sudden, severe abdominal pain that is disproportionate to physical examination findings. He also reports vomiting and the passage of blood in his stool. Given his history and clinical presentation, which artery is most likely involved in this patient's condition?", "options": [{"label": "A", "text": "Superior Mesenteric Vein", "correct": false}, {"label": "B", "text": "Superior Mesenteric Artery", "correct": true}, {"label": "C", "text": "Inferior Mesenteric Artery", "correct": false}, {"label": "D", "text": "Inferior Mesenteric Vein", "correct": false}], "correct_answer": "B. Superior Mesenteric Artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8p8fMoEuTk3snWCDyS4a1740043764.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden reduction in blood supply to the intestines, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and potential necrosis.</li>\n<li>Commonly involves the Superior mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (SMA).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pain:</strong> Severe, sudden-onset <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain disproportionate to physical findings.</li>\n<li><strong>Others:</strong> Nausea, vomiting, diarrhea, bloody stools, shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cardiovascular:</strong> Atrial fibrillation, recent MI, heart failure.</li>\n<li><strong>Vascular:</strong> Atherosclerosis, vasculitis.</li>\n<li><strong>Others:</strong> Hypercoagulable states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Angiography:</strong> Preferred <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool; reveals SMA occlusion, <strong>String of sausage sign</strong>, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall thickening, <span class=\"customMeta\" data-dictid=\"8b4d9f2762169277719595156f1088\">pneumatosis</span> intestinalis, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> gas.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"J. Jacobsen, Ulrik R Beierholm, R. Mikkelsen, F. Gustafsson, P. Alstrøm, N. Holstein-Rathlou\" data-hash=\"\" data-license=\"NA\" data-source='Figure 4 from \"Sausage-string\" appearance of arteries and arterioles can be caused by an instability of the blood vessel wall. | Semantic Scholar' data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/8p8fMoEuTk3snWCDyS4a1740043764.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Initial:</strong> IV fluids, <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics, pain control.</li>\n<li><strong>Definitive:</strong> <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">Anticoagulation</span> (e.g., IV heparin), <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> embolectomy, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> resection. Vasodilators (e.g., papaverine) can be used intra-arterially to relieve vasospasm.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ziLaQgGH09wGrqEIrmyH1748754671.mp3", "video": ""}, {"text": "A 24-year-old woman presents with episodic colour changes in her fingers triggered by cold temperatures and stress. The episodes follow a characteristic sequence. What is the correct sequence of events in the skin colour changes seen in the Raynaud phenomenon?", "options": [{"label": "A", "text": "Rubor → Cyanosis → Pallor", "correct": false}, {"label": "B", "text": "Cyanosis → Pallor → Rubor", "correct": false}, {"label": "C", "text": "Pallor → Cyanosis → Rubor", "correct": true}, {"label": "D", "text": "Rubor → Pallor → Cyanosis", "correct": false}], "correct_answer": "C. Pallor → Cyanosis → Rubor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YXpNjX4c1OHqkeA9Cz0m1740043657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Raynaud phenomenon is characterized by episodic reduction in blood flow, typically in the fingers, <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by cold exposure or stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pallor:</strong> Skin becomes pale or white due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow.</li>\n<li><strong>Cyanosis:</strong> Skin turns blue or purple due to <span class=\"customMeta\" data-dictid=\"2819f49f1a169277718587145c3004\">deoxygenation</span> of blood.</li>\n<li><strong>Rubor:</strong> Skin turns red as <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> returns, often with <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and tingling.</li>\n<li><strong>Cold Sensitivity:</strong> Cold, <span class=\"customMeta\" data-dictid=\"c1f2cd78a916927771936efc6a16cf\">numb</span> fingers.</li>\n<li><strong>Pain:</strong> Pain during the cyanotic phase.</li>\n<li><strong>Swelling and Tingling:</strong> Occurs in the <span class=\"customMeta\" data-dictid=\"04658981de1692777197ed1ff49228\">rubor</span> phase.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary Raynaud Phenomenon (Raynaud Disease):</strong>\n<ul>\n<li>Occurs without underlying disease.</li>\n<li>More common and has a better prognosis.</li>\n</ul>\n</li>\n<li><strong>Secondary Raynaud Phenomenon (Raynaud Syndrome):</strong>\n<ul>\n<li>Occurs due to an underlying condition (e.g., scleroderma, lupus).</li>\n<li>Often more severe.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lifestyle Modifications:</strong> Avoid cold exposure, stress reduction, and smoking cessation.</li>\n<li><strong>Medications:</strong> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> channel blockers (e.g., nifedipine), alpha-blockers (e.g., prazosin), and other vasodilators.</li>\n<li><strong>Avoidance of Triggers:</strong> Avoid cold, beta-blockers, and caffeine.</li>\n<li><strong>Advanced Treatments:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"1c33ea213b1692777199f5837fbe93\">sympathectomy</span> for severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clinical Presentation and History:</strong> Based on symptoms and triggers.</li>\n<li><strong>Nailfold Capillaroscopy:</strong> To examine <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> changes.</li>\n<li><strong>Blood Tests:</strong> To identify underlying <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> or <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue diseases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/57aISizUJEUVQoAS49Xz1748754532.mp3", "video": ""}, {"text": "A 58-year-old male presents to the emergency department with a sudden onset of severe pain in his left leg. The leg appears pale and feels cold to the touch, and the patient is unable to move or feel his toes. On examination, no pulses are detectable below the knee. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Deep vein thrombosis", "correct": false}, {"label": "B", "text": "Acute limb ischemia", "correct": true}, {"label": "C", "text": "Chronic venous insufficiency", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "B. Acute limb ischemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7QQoy6nDIPtvb5jhOnxI1748751956.mp3", "video": ""}, {"text": "A 65-year-old male presents with a sudden onset of severe pain in his left leg, which has become cold and pale. On examination, there is an absence of distal pulses. Imaging reveals a large saddle embolus at the aortic bifurcation. What is the most appropriate catheter to use for embolectomy in this case?", "options": [{"label": "A", "text": "Seldinger catheter", "correct": false}, {"label": "B", "text": "Swan-Ganz catheter", "correct": false}, {"label": "C", "text": "Fogarty catheter", "correct": true}, {"label": "D", "text": "Tenckhoff catheter", "correct": false}], "correct_answer": "C. Fogarty catheter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LVX6pdpg71El2eQYGwey1740043057.png", "https://image.prepladder.com/content/mJ7XsM1zsknOTV3QyzRd1740043121.png", "https://image.prepladder.com/content/ZM2qEEQaDqRB6m7BmLNr1740043151.png", "https://image.prepladder.com/content/FQo113Vo8iytlotsgxKf1740043184.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wOBEAkeTHUqHUPA0UxJp1748753846.mp3", "video": ""}, {"text": "A 60-year-old male with end-stage renal disease is scheduled for the creation of a surgically created arteriovenous (AV) fistula to facilitate long-term hemodialysis. Which of the following is the most commonly used type of AV fistula for this purpose?", "options": [{"label": "A", "text": "Cimino-Brescia fistula", "correct": true}, {"label": "B", "text": "Blalock-Taussig shunt", "correct": false}, {"label": "C", "text": "Snuff box fistula", "correct": false}, {"label": "D", "text": "Axillary-axillary loop graf", "correct": false}], "correct_answer": "A. Cimino-Brescia fistula", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vGQLQaBNfQpPI2oIsDE41740042919.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:529px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Purpose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for hemodialysis</li>\n<li>Provides high <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> for effective dialysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Site Selection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prefer <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> placement</li>\n<li>Non-dominant arm is typically used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arterial Quality</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires a strong arterial pulse for success</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vein Preservation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoid placing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> lines in the arm intended for fistula</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XokYEJc6SQf87fUei1hV1748753561.mp3", "video": ""}, {"text": "A 46-year-old male presents with intense pain in his left leg along with the following lesion. Which of the following is the most probable diagnosis?", "options": [{"label": "A", "text": "Neuropathic ulcer", "correct": false}, {"label": "B", "text": "Venous ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": true}, {"label": "D", "text": "Pressure ulcer", "correct": false}], "correct_answer": "C. Arterial ulcer", "question_images": ["https://image.prepladder.com/content/KXFSAs461Cyr13wTQgay1740042833.png"], "explanation_images": ["https://image.prepladder.com/content/0JfYWqKwudtY5YcCFWxb1740042875.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous ulcer</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial ulcer</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuropathic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure ulcer</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gaiter’s area</strong> (area between <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> and calf)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ends of limbs, such as toes, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> and legs.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over toe joints, under the heel, over malleoli, under the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> head, etc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen over pressure points, most common are ischium, greater trochanter, sacrum, hee, malleolus, occiput, etc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertically <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> with a sloping edge and will not penetrate deep fascia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Punched-out edges </strong>are seen in this type of ulcer.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcers can be associated with <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> and abscesses; <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> can be seen here.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Punched out <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with<strong> bone as a base.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> due to <strong>varicose veins.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This occurs due to severe arterial <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> of digital and medium-sized arteries, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and tissue death in the region.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is caused due to repeated trauma and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> due to <strong>microangiopathy</strong> in <strong>diabetic patients</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> due to prolonged pressure on any part of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is initially painful, then chronically becomes painless.</p>\n<p>It heals on rest and treatment but reforms again.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is intensely painful, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses are not palpable, associated with shiny skin, <span class=\"customMeta\" data-dictid=\"e30073048816927771830d431eabfe\">brittle</span> nails and loss of hair over the region.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Also known as <strong>diabetic ulcer</strong> since it is seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is common in bedridden patients with head injuries, neurological deficits, and <span class=\"customMeta\" data-dictid=\"60dcb15b7616927771846fa5872355\">comatose</span> and stroke-ridden patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/O5RE9ol5y0m2X8kQgnlx1748753447.mp3", "video": ""}, {"text": "A 35-year-old male with a 12-year history of smoking presents with severe rest pain and discoloration of the left lower limb's digits as shown below. He has experienced worsening pain in this limb for the past 2 days, following 3 months of discomfort. What is the appropriate management for this condition?", "options": [{"label": "A", "text": "Lumbar sympathectomy", "correct": false}, {"label": "B", "text": "Abstinence from smoking", "correct": false}, {"label": "C", "text": "Amputation", "correct": true}, {"label": "D", "text": "Vasodilators", "correct": false}], "correct_answer": "C. Amputation", "question_images": ["https://image.prepladder.com/content/3AzhXlSZINGgWGphnwPA1740042780.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CUI0r2Sov5FPMEaknIkK1748753294.mp3", "video": ""}, {"text": "A 56-year-old male presents with sudden pain and numbness in his right lower limb for 1 day. On examination, the limb is cold and pale and exhibits loss of sensory and mild motor functions. Doppler studies reveal only venous signals. What grade of Rutherford's classification is this case?", "options": [{"label": "A", "text": "Grade I", "correct": false}, {"label": "B", "text": "Grade IIA", "correct": false}, {"label": "C", "text": "Grade IIB", "correct": true}, {"label": "D", "text": "Grade III", "correct": false}], "correct_answer": "C. Grade IIB", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:756px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor deficit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">doppler</span> signals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">doppler</span> signals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Viable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>none</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>none</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Audible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Audible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No immediate threat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIA</strong></p>\n<p><strong>(Option B</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marginally Threatened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None or minimal (toes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>none</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inaudible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Audible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Salvageable if promptly treated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIB</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediately threatened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than toes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild/moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inaudible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Audible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Salvageable with immediate revascularisation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irreversible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound or insensate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paralyzed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inaudible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inaudible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limb is irreversibly damaged, major tissue loss, and amputation.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:547px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IIA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> (can walk &gt;200 meters)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IIB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate to severe <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> (can only walk 200 meters or less)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rest pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Critical limb <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> leading to <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> + gangrene.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sluHLZgxTiXR7BYuCfuZ1748753010.mp3", "video": ""}, {"text": "A 38-year-old chronic smoker presents with lower limb pain during walking for 2 weeks. Examination reveals an ankle-to-brachial systolic pressure ratio of 0.7. What is the correct interpretation of this finding?", "options": [{"label": "A", "text": "Critical limb ischemia", "correct": false}, {"label": "B", "text": "Intermittent claudication", "correct": true}, {"label": "C", "text": "Normal index", "correct": false}, {"label": "D", "text": "Calcified vessels", "correct": false}], "correct_answer": "B. Intermittent claudication", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:501px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ABI / ABPI = <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP in the Ankle/ <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP in the arm</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:527px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.1 - 0.4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Critical limb <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5 - 0.9</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermittent <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.0 - 1.2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal<strong> </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 1.2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcified vessels (seen in patients with DM, End stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease)<strong> (Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8VNincgtdMmMMAWAERS91748752574.mp3", "video": ""}, {"text": "What is the most specific investigation of choice for peripheral arterial disease?", "options": [{"label": "A", "text": "Ankle-Brachial Index", "correct": false}, {"label": "B", "text": "Duplex ultrasonography", "correct": false}, {"label": "C", "text": "CT angiography", "correct": true}, {"label": "D", "text": "Magnetic Resonance Angiography", "correct": false}], "correct_answer": "C. CT angiography", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7l5INpAHL6BnkDX518EM1740042692.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4klwBH4xSlLztlYLSpY51748752293.mp3", "video": ""}, {"text": "A 65-year-old man presents with pain in his right calf that occurs after walking 200 meters and is relieved by rest. The pain does not occur when he is at rest or when he walks shorter distances. Based on Boyd's classification of intermittent claudication, which grade best describes this patient's condition?", "options": [{"label": "A", "text": "Grade 0", "correct": false}, {"label": "B", "text": "Grade I", "correct": false}, {"label": "C", "text": "Grade II", "correct": true}, {"label": "D", "text": "Grade III", "correct": false}], "correct_answer": "C. Grade II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 0: Asymptomatic (Option A ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No symptoms of claudication, even with exercise</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I: Mild <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk more than 200 meters (about 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II: Moderate <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> (option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk between 50 and 200 meters (about 160 to 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III: Severe <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk less than 50 meters (about 160 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV: Ischemic rest pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain occurs at rest or with minimal exertion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BMTtLaf1tqGc6et1vAnO1747153201.mp3", "video": ""}, {"text": "A 40-year-old male presents with pain in his hands and feet, which worsens with cold exposure. He has a history of heavy smoking. On examination, he has ulcers on his fingers and toes. Angiography reveals \"corkscrew\" collaterals and segmental occlusions. Which of the following conditions is most likely in this patient?", "options": [{"label": "A", "text": "Systemic sclerosis", "correct": false}, {"label": "B", "text": "Thromboangiitis obliterans", "correct": true}, {"label": "C", "text": "Atherosclerosis", "correct": false}, {"label": "D", "text": "Frostbite", "correct": false}], "correct_answer": "B. Thromboangiitis obliterans", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OdrabZ22cbQiiMm2cumX1740042606.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Buerger's Disease</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atherosclerosis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually &lt;45 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically &gt;50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gender predominance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong male predominance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Male &gt; Female</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heavy smoking (essential for diagnosis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking, hypertension, diabetes, hyperlipidemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammatory thrombosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipid accumulation, inflammation, <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vessels affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small and medium-sized arteries and veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large and medium-sized arteries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper and lower extremities equally</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower extremities &gt; Upper extremities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute episodes with periods of remission</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual onset, chronic course</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angiography shows \"corkscrew\" collaterals, <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> occlusions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angiography shows <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> narrowing, calcification</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking cessation is essential but has a limited role in revascularization.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk factor modification, <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> therapy, revascularisation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IWZEE62K7VaY6yVxPFIH1748752186.mp3", "video": ""}, {"text": "A 72-year-old man presents with a sudden onset of severe pain, numbness, and coldness in his left leg. On examination, the left leg appears pale, and no pulse is palpable below the femoral artery. What is the most probable cause of this acute peripheral arterial occlusion?", "options": [{"label": "A", "text": "Atherosclerosis", "correct": true}, {"label": "B", "text": "Buerger's disease", "correct": false}, {"label": "C", "text": "Fibromuscular dysplasia", "correct": false}, {"label": "D", "text": "Arterial dissection", "correct": false}], "correct_answer": "A. Atherosclerosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Atherosclerosis (Most common)</li>\n<li>Embolism</li>\n<li>Thrombosis</li>\n<li>Trauma</li>\n</ul>\n</td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Vasculitis (e.g., Buerger’s disease)</li>\n<li>Fibromuscular dysplasia</li>\n<li>Arterial dissection</li>\n<li>Extrinsic compression</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites of Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Related Manifestations/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aorta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infrarenal aorta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iliac arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> bifurcation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulse</p>\n<p>Pain in the buttock is due to a block in the common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> or <span class=\"customMeta\" data-dictid=\"5e1cbaefc31692777181f98722a8f6\">aortoiliac</span> segment (30%), often associated with impotence</p>\n<p>and is called as <strong>Leriche's syndrome.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Femoral artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calf claudication, absent popliteal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Popliteal artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adductor canal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calf and foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tibial arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal or mid-calf</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subclavian artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal subclavian</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arm ischemia, absent radial/ulnar pulses</p>\n<p><strong><u>Subclavian steal syndrome:</u></strong></p>\n<p>Obstruction of the first part of the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> can cause reverse <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the vertebral artery, providing <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> to the arm but affecting the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> brain and upper limb, with steal being occult, partial, or complete.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brachial artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-humerus level</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forearm and hand ischemia, absent radial/ulnar pulses</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KxAEUh2YTMywm4GVWGg91748752076.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 40-year-old female presents with persistent swelling in her lower legs. Upon physical examination, the swelling is noted to be non-pitting, and the patient has no signs of irreversible skin changes. What is the most appropriate Brunner's classification grade for her condition?", "options": [{"label": "A", "text": "Subclinical/latent", "correct": false}, {"label": "B", "text": "Grade I", "correct": false}, {"label": "C", "text": "Grade II", "correct": true}, {"label": "D", "text": "Grade III", "correct": false}], "correct_answer": "C. Grade II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grades</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subclinical/Latent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excess <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> fluid.</li>\n<li>Histological <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in lymphatics &amp; <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</li>\n<li>No clinically apparent lymphedema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pitting edema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-pitting edema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Edema with <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> skin changes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VT4hXe4KaID5ZW4E5HgP1746110623.mp3", "video": ""}, {"text": "A 60-year-old female with severe lymphedema of the lower limb, not responding to conservative therapies. Due to persistent swelling and functional impairment, she undergoes surgical intervention. An image of the surgical procedure is shown below. What is the procedure known as?", "options": [{"label": "A", "text": "Thompson Procedure", "correct": true}, {"label": "B", "text": "Charles Procedure", "correct": false}, {"label": "C", "text": "Nielubowicz Operation", "correct": false}, {"label": "D", "text": "Kinmonth procedure", "correct": false}], "correct_answer": "A. Thompson Procedure", "question_images": ["https://image.prepladder.com/content/MDED3htagt2YZAWPBJiy1739957535.png"], "explanation_images": ["https://image.prepladder.com/content/24YonepJlNo1b3rXalQD1739957560.png", "https://image.prepladder.com/content/jHUv4aru8GqcHlEki9tz1739957575.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reconstructive Operation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is indicated in patients with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> (either primary or secondary) <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of the extremity, <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> obstruction, and dilated lymphatics <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the obstruction.</li>\n<li>Bypass procedures:\n\t\t\t\t<ul>\n<li>Omental pedicle.</li>\n<li>Skin bridge (<strong>Gillies</strong>).</li>\n<li>Anastomosing <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes to veins (<strong>Neibulowitz</strong>).</li>\n<li>Ileal mucosal patch (<strong>Kinmonth</strong>).</li>\n<li>Direct lymphovenous <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> with the aid of an operating microscope</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Excisional Operation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The only <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> option for patients without <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> lymphatics of adequate size for reconstructive procedures.</li>\n<li><strong>Sistrunk:</strong>\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"b3c25aa68616927772025ab4ff7a11\">wedge</span> of skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue is excised, and the wound is closed primarily.</li>\n<li>It is most commonly carried out to reduce the girth of the thigh.</li>\n</ul>\n</li>\n<li><strong>Kondoleon's or Homan's:</strong>\n<ul>\n<li>Staged <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> underneath flaps.</li>\n</ul>\n</li>\n<li><strong>Thompson:</strong>\n<ul>\n<li>The denuded skin <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> is sutured to the deep <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and buried beneath the second skin <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> (‘buried <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> flap’).</li>\n</ul>\n</li>\n<li><strong>Charles Procedure:</strong>\n<ul>\n<li>In severe <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> with unhealthy and infected skin.</li>\n<li>Involves complete and <span class=\"customMeta\" data-dictid=\"57793361701692777184c3bc13c91d\">circumferential</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of skin, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue and deep <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> of the involved leg and <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the foot.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pCmt46djf0TvILXS689D1746111141.mp3", "video": ""}, {"text": "A patient with breast carcinoma after 11 years of Modified radical mastectomy and radiotherapy, now presents with pain, skin nodules and worsening of swelling of left arm as shown in the image below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Lymphangiosarcoma", "correct": true}, {"label": "B", "text": "Venous thrombosis", "correct": false}, {"label": "C", "text": "Cellulitis", "correct": false}, {"label": "D", "text": "Lymphedema", "correct": false}], "correct_answer": "A. Lymphangiosarcoma", "question_images": ["https://image.prepladder.com/content/YZArRuhKexnfoCWTKpyo1739957732.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Y7zkoLDa3ayQER2Lony11746111700.mp3", "video": ""}, {"text": "A 35-year-old man presents to the emergency department with a rapidly spreading reddish streak on his left arm, accompanied by fever and swollen axillary lymph nodes. He reports sustaining a small cut on his hand two days ago while gardening. Physical examination reveals a tender, warm, erythematous streak extending from the hand to the upper arm, with blanching on pressure. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Immediate surgical incision and drainage of the affected area", "correct": false}, {"label": "B", "text": "Oral antihistamines and topical corticosteroids", "correct": false}, {"label": "C", "text": "Limb elevation and initiation of intravenous antibiotics like penicillin or cloxacillin", "correct": true}, {"label": "D", "text": "Watchful waiting for 48 hours before initiating any treatment", "correct": false}], "correct_answer": "C. Limb elevation and initiation of intravenous antibiotics like penicillin or cloxacillin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VGGFylFvnFsINfqecGG91739957057.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute nonsuppurative infection and <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of lymphatics of skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Beta-hemolytic streptococci</p>\n<p>• Staphylococci</p>\n<p>• <span class=\"customMeta\" data-dictid=\"c7f3ed2cd01692777184f7adb1b0e9\">Clostridial</span> organisms (less common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Small trauma or skin break</p>\n<p>• In <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas: <span class=\"customMeta\" data-dictid=\"afbac905ef1692777202ab62b5c1be\">Wuchereria</span> bancrofti (transmitted by <span class=\"customMeta\" data-dictid=\"8821feceff1692777185b2fc88c7dd\">Culex</span> mosquito)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Streaky redness which is <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> <strong>(typical)</strong></p>\n<p>• Pain</p>\n<p>• Fever</p>\n<p>• <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">Palpable</span> tender regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n<p>• Blanching on pressure</p>\n<p>• Fever, <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> (features of toxemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> formation</p>\n<p>• Toxaemia, septicemia</p>\n<p>• Chronic <span class=\"customMeta\" data-dictid=\"3291840e671692777191144a261bdd\">lymphangitis</span> leading to <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> lymphoedema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Complete blood count</p>\n<p>• <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> and liver function tests</p>\n<p>• Blood culture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">Broad-spectrum</span> antibiotics (e.g. penicillin, cloxacillin)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">Elevation</span> and rest of affected limb</p>\n<p>• Glycerine <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> sulphate dressing</p>\n<p>• Management of <span class=\"customMeta\" data-dictid=\"24745931fe169277720026e1cb7d2f\">toxemia</span> or <span class=\"customMeta\" data-dictid=\"afd363657e16927771982285d861d6\">septicemia</span> if present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UfSR4JIvZ6rtknXljnLU1746110024.mp3", "video": ""}, {"text": "A 55-year-old woman presents with chronic swelling of her left arm. She has a history of breast cancer treatment 2 years ago. Which of the following is the most common iatrogenic cause of lymphedema in this patient's scenario?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Lymph node dissection", "correct": true}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Biologic Targeted Therapy", "correct": false}], "correct_answer": "B. Lymph node dissection", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ References:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Lymphedema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital Lymphedema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Present at birth or &lt;2 years</li>\n<li>Familial type is called Nonne-Milroy's disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphedema Praecox</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>M/C type of primary <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> (&gt;90% of cases)</li>\n</ul>\n<ul>\n<li>Age - 1 to 35 years</li>\n<li>M/C in females</li>\n<li>Familial version is called Meig's disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphedema Tarda</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age: Seen in &gt; 35 years age group</li>\n<li>It is a rare disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Secondary Lymphedema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filariasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>MC overall cause</strong> of <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> worldwide</li>\n<li><strong>MC secondary cause</strong> of lymphedema</li>\n<li>Lymphoedema due to<strong> <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">Lymphatic</span> obstruction</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Axillary block dissection-</strong></li>\n</ul>\n<ul>\n<li><strong>MC cause of secondary lymphedema</strong> in the USA</li>\n<li><strong>MC <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> cause</strong> of secondary lymphedema</li>\n</ul>\n<ul>\n<li>Inguinal block dissection</li>\n<li>Lymphedema due to <strong>Lymphatic disruption</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infections</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tuberculosis</li>\n<li>Syphilis</li>\n<li>Fungal and Bacterial infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other causes:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trauma</li>\n<li>Malignancy</li>\n<li>Radiotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LPkIV1Bscsv0udTmrZzB1746110310.mp3", "video": ""}, {"text": "A 25-year-old female presents with swelling in her right calf and foot, which has gradually worsened over the past few years. She reports that the swelling started in her teenage years and has become more pronounced with time. What is the diagnosis in this patient?", "options": [{"label": "A", "text": "Congenital lymphedema", "correct": false}, {"label": "B", "text": "Lymphedema praecox", "correct": true}, {"label": "C", "text": "Lymphedema tarda", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Lymphedema praecox", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Congenital <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">Lymphedema</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymphedema <span class=\"customMeta\" data-dictid=\"96400dd4d61692777196c9a5ea1493\">Praecox</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymphedema Tarda </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age: Seen in &lt; 1 year of age</li>\n<li>Present at birth.</li>\n<li>Lower limb, genitalia, and face are involved.</li>\n<li>Usually B/L and multiple limbs are involved.</li>\n<li>Familial version of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> – known as <strong>Milroy’s disease.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>M/C type of primary <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> (&gt;90% of cases).</li>\n<li>Age: 1 to 35 years.</li>\n<li>M/C seen in females.</li>\n<li>Usually U/L.</li>\n<li>Involves calf and foot</li>\n<li>Familial version of <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> <span class=\"customMeta\" data-dictid=\"96400dd4d61692777196c9a5ea1493\">praecox</span> - known as <strong>Meig's disease.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age: Usually seen in &gt; 35 years age group</li>\n<li>It is a rare disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LavskKCqDFQIS1blyXLr1746110437.mp3", "video": ""}, {"text": "A 55-year-old male with chronic leg swelling presents with difficulty pinching the skin over the dorsum of his foot. What is this sign known as?", "options": [{"label": "A", "text": "Buffalo hump", "correct": false}, {"label": "B", "text": "Square toes", "correct": false}, {"label": "C", "text": "Stemmer's sign", "correct": true}, {"label": "D", "text": "Merkel's sign", "correct": false}], "correct_answer": "C. Stemmer's sign", "question_images": ["https://image.prepladder.com/content/JCzDydk13jNJqdRFyADY1739957382.png"], "explanation_images": ["https://image.prepladder.com/content/TYgG40OwVRSgn5cfMLBJ1739957274.png", "https://image.prepladder.com/content/FC7nai6RLil9fJDhr5GO1739957309.png", "https://image.prepladder.com/content/OeetiD1l5eKVZBOpjYHH1739957227.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4Bp9KG3lCZf0fq4weHjm1746106236.mp3", "video": ""}, {"text": "Which of the following is the least preferred treatment option for early management of lymphedema?", "options": [{"label": "A", "text": "Use of compression stockings", "correct": false}, {"label": "B", "text": "Limb elevation, regular check-up", "correct": false}, {"label": "C", "text": "Specialized complex physical therapy", "correct": false}, {"label": "D", "text": "Nielubowicz procedure", "correct": true}], "correct_answer": "D. Nielubowicz procedure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MoNLrhf1YwxDoQgoUdJz1739957458.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yhUOu3d32bzNLEwZ82x21746110951.mp3", "video": ""}, {"text": "A 4-month-old baby is brought to the hospital with complaints of swelling in the neck as given in the image and diagnosed as cystic hygroma. Which of the following is true regarding the condition?", "options": [{"label": "A", "text": "Swelling presents after the age of 1 year", "correct": false}, {"label": "B", "text": "It is a benign tumor", "correct": true}, {"label": "C", "text": "Laser excision is the treatment of choice", "correct": false}, {"label": "D", "text": "The size remains constant throughout the life", "correct": false}], "correct_answer": "B. It is a benign tumor", "question_images": ["https://image.prepladder.com/content/5ZIC3DkaG4SqyT7Nm1sk1739957670.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eVIRcDQxTWxWlz5xBk871746111345.mp3", "video": ""}, {"text": "Identify the given condition and choose among the following:", "options": [{"label": "A", "text": "Stewart - Treves syndrome", "correct": true}, {"label": "B", "text": "Lymphedema", "correct": false}, {"label": "C", "text": "Cystic hygroma", "correct": false}, {"label": "D", "text": "Marjolin’s ulcer", "correct": false}], "correct_answer": "A. Stewart - Treves syndrome", "question_images": ["https://image.prepladder.com/content/SCfrlFJbOOwaOs0AGORE1739957783.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9hm3ljtAgRiAcvEre9pZ1746111812.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What is the most likely diagnosis of the lesion shown in the image below?", "options": [{"label": "A", "text": "Arterial insufficiency", "correct": false}, {"label": "B", "text": "Neuropathic ulcer", "correct": true}, {"label": "C", "text": "Venous ulcer", "correct": false}, {"label": "D", "text": "Tuberculous ulcer", "correct": false}], "correct_answer": "B. Neuropathic ulcer", "question_images": ["https://image.prepladder.com/notes/y7ifeGz1oMQbuCU9nmf11746600683.png"], "explanation_images": ["https://image.prepladder.com/content/ryy7YvhUIXDXrsAppZc41745584035.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:746px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features of different ulcers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Venous ulcer</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arterial ulcer</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuropathic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pressure ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gaiter’s area</strong> (area between <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> and calf)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ends of limbs, such as toes, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> and legs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over toe joints, under the feet, heel, over malleoli, under the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> head, etc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen over pressure points, most common are ischium, greater trochanter, sacrum, hee, malleolus, occiput, etc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vertically <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> with a sloping edge and will not penetrate deep fascia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punched-out edges </strong>are seen in this type of ulcer.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcers can be associated with <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> and abscesses; <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> can be seen here.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Punched out <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with<strong> bone as a base.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> due to <strong>varicose veins.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This occurs due to severe arterial <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> of digital and medium-sized arteries, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and tissue death in the region.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is caused due to repeated trauma and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> due to <strong>microangiopathy</strong> in <strong>diabetic patients</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> due to prolonged pressure on any part of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is initially painful, then chronically becomes painless.</p>\n<p>It heals on rest and treatment but reforms again.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is intensely painful; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses are not palpable, and associated with shiny skin, <span class=\"customMeta\" data-dictid=\"e30073048816927771830d431eabfe\">brittle</span> nails and loss of hair over the region.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is also known as <strong>diabetic ulcer</strong> since it is seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is common in bedridden patients with head injuries, neurological deficits, and <span class=\"customMeta\" data-dictid=\"60dcb15b7616927771846fa5872355\">comatose</span> and stroke-ridden patients.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"488\" src=\"https://image.prepladder.com/content/ryy7YvhUIXDXrsAppZc41745584035.png\" width=\"488\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following findings is likely to be seen in this patient?", "options": [{"label": "A", "text": "Decreased posterior tibial &amp;amp; dorasalis pedis pulsations", "correct": false}, {"label": "B", "text": "Loss of sensation over the foot", "correct": true}, {"label": "C", "text": "Positive tredelenberg sign", "correct": false}, {"label": "D", "text": "Pain on compression of the calf", "correct": false}], "correct_answer": "B. Loss of sensation over the foot", "question_images": ["https://image.prepladder.com/notes/JvTijMWQgRTMxCN5gipx1745336559.jpg"], "explanation_images": ["https://image.prepladder.com/notes/5fm3DEvi0QAiJalOJq8n1745336560.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurotrophic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gaiter’s area</strong> (area between <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> and calf)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ends of limbs, such as toes, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> and legs.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over toe joints, under the heel, over malleoli, under the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> head, etc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen over pressure points, most common are ischium, greater trochanter, sacrum, hee, malleolus, occiput, etc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertically <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> with a sloping edge and will not penetrate deep fascia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Punched-out edges </strong>are seen in this type of ulcer.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcers can be associated with <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> and abscesses; <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> can be seen here.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Punched out <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with<strong> bone as a base.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> due to <strong>varicose veins.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This occurs due to severe arterial <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> of digital and medium-sized arteries, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and tissue death in the region.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is caused due to repeated trauma and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> due to <strong>microangiopathy</strong> in <strong>diabetic patients</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> due to prolonged pressure on any part of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is initially painful, then chronically becomes painless.</p>\n<p>It heals on rest and treatment but reforms again.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is intensely painful, and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses are not palpable, and associated with shiny skin, <span class=\"customMeta\" data-dictid=\"e30073048816927771830d431eabfe\">brittle</span> nails and loss of hair over the region.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numbness</p>\n<p>Paresthesias</p>\n<p>Burning or loss of sensation in the foot</p>\n<p>Diabetes mellitus (also known as <strong>diabetic ulcer</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is common in bedridden patients with head injuries, neurological deficits, and <span class=\"customMeta\" data-dictid=\"60dcb15b7616927771846fa5872355\">comatose</span> and stroke-ridden patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male chronic smoker presents with pain in the fingers for a few months. On examination, gangrenous ulcers were present in the fingers, as shown below. Investigation showed blood glucose and lipid profile within normal limits. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Buerger’s disease", "correct": true}, {"label": "B", "text": "Diabetic ulcers", "correct": false}, {"label": "C", "text": "Acute paronychia", "correct": false}, {"label": "D", "text": "Raynaud’s phenomenon", "correct": false}], "correct_answer": "A. Buerger’s disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Buerger’s disease</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-atherosclerotic, <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> affecting small &amp; medium-sized arteries and veins.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong association with tobacco use (smoking or chewing). Exact cause unknown (likely immune-mediated).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Young males (20–45 years), most commonly smokers.</p>\n<p>More common in Middle East, South Asia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammation leads to <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> occlusion.</li>\n<li>Sparing of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> arteries (unlike atherosclerosis).</li>\n<li>Segmental involvement (skip lesions).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Claudication, <span class=\"customMeta\" data-dictid=\"13b8c213ce1692777197b4b758ae57\">rest pain</span> (foot, hands).</li>\n<li>Raynaud’s phenomenon (vasospasm causing colour changes in fingers/toes).</li>\n<li>Ulcers &amp; <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> (especially in fingers/toes).</li>\n<li>Migratory <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"31f2c60d1e1692777200a4eae70af9\">thrombophlebitis</span> (inflamed veins).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis (no specific lab tests).</li>\n<li>Doppler &amp; <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> → Corkscrew <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> vessels (pathognomonic).</li>\n<li>Exclusion of other causes (diabetes, atherosclerosis, vasculitis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Complete smoking cessation (most important).</li>\n<li>Vasodilators (e.g., <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers for Raynaud’s).</li>\n<li>Antiplatelets &amp; anticoagulants (limited benefit).</li>\n<li>Pain management (NSAIDs, opioids if needed).</li>\n<li>Amputation (for non-healing ulcers or gangrene).</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor if smoking continues but stabilises with smoking cessation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable medical condition for an 80-year-old male who experienced pain and swelling in the calf muscle on the right side after being immobilized due to a fracture in the right inter-trochanteric region?", "options": [{"label": "A", "text": "Chronic osteomyelitis", "correct": false}, {"label": "B", "text": "Deep vein thrombosis", "correct": true}, {"label": "C", "text": "Compartment syndrome", "correct": false}, {"label": "D", "text": "Arterial claudication", "correct": false}], "correct_answer": "B. Deep vein thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) Deep &lt;span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\"&gt;vein&lt;/span&gt; th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male patient involved in a road traffic accident was managed upon arrival at the emergency room, with a respiratory rate of 25 breaths per minute and a blood pressure of 80/45mmHg, and exhibiting hyper-resonance on the left side of the chest, what is the appropriate action based on the findings from the chest x-ray?", "options": [{"label": "A", "text": "Wide bore needle insertion in the 2nd ICS", "correct": false}, {"label": "B", "text": "Wide bore needle insertion in the 5th ICS followed by an intercostal drain in the 5th ICS", "correct": true}, {"label": "C", "text": "Aspiration of the pleural fluid", "correct": false}, {"label": "D", "text": "No intervention needed", "correct": false}], "correct_answer": "B. Wide bore needle insertion in the 5th ICS followed by an intercostal drain in the 5th ICS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h4wUIbQhdc3EkbZfSSjH1746009316.png", "https://image.prepladder.com/content/nwGunM4Cld58jCukrHlF1746009316.png"], "explanation": "<p>Correct answer B) Wide bore needle &lt;span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\"&gt;insertion&lt;/span&gt; in the 5th ICS followed by an &lt;span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\"&gt;intercostal&lt;/span&gt; drain in the 5th ICS\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Tension Pneumothorax</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>D/t<strong> ‘one-way valve’</strong> air leaks from the lung or chest wall.</li>\n<li>Air is sucked into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> without any escape, collapsing and compressing the affected lung.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> shifts to the opposite side, reducing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return and compressing the opposite lung, leading to decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and function. This can result in sudden death.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"513\" src=\"https://image.prepladder.com/content/h4wUIbQhdc3EkbZfSSjH1746009316.png\" width=\"513\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Penetrating Chest Trauma.</li>\n<li>Blunt Chest Trauma with parenchymal lung injury and persistent air leak.</li>\n<li>Iatrogenic Lung Injury (e.g., central venepuncture)</li>\n<li>Mechanical Positive-Pressure Ventilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tachypnea and Tachycardia</li>\n<li>Hyper-resonance and Decreased/Absent Breath Sounds</li>\n<li>Resonant Percussion with severe mediastinal/tracheal shift</li>\n<li>Cyanosis and Hypotension</li>\n<li>Chest Pain</li>\n<li>Distended Neck Veins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Emergency Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> is a clinical diagnosis, and treatment should never be delayed by waiting for radiological confirmation.</li>\n<li>Immediate Thoracocentesis (needle): Wide bore needle (typically a 20- or 22-gauge) in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the safety triangle.</li>\n<li>Decompression should be performed in the \"safe triangle.\"</li>\n</ul>\n<ul>\n<li><strong>Safe <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> Boundaries</strong>:\n\n\t\t\t\t<ul>\n<li>Posterior: Latissimus dorsi</li>\n<li>Anterior: Lateral border of the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major</li>\n<li>Inferior: A line drawn perpendicularly from the <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> to the back, just <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the mid-axillary line.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"430\" src=\"https://image.prepladder.com/content/nwGunM4Cld58jCukrHlF1746009316.png\" width=\"430\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>In critical situations, a finger <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> can be done in the same location.</li>\n</ul>\n<ul>\n<li>Nasal Oxygen for support.</li>\n<li>Intercostal Tube Placement (ICT) once stable and confirmed by chest X-ray.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Care </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Antibiotics and analgesics for treatment.</li>\n<li>Ventilator Support with IPPV in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery, for which she was immobilised. Patient started complaining of leg pain on the 5th postoperative day. On examination , Homan’s sign is positive. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Deep Venous thrombosis", "correct": true}, {"label": "B", "text": "Urinary sepsis", "correct": false}, {"label": "C", "text": "Peripheral vascular disease", "correct": false}, {"label": "D", "text": "Lymphangitis", "correct": false}], "correct_answer": "A. Deep Venous thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Deep &lt;span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\"&gt;Venous&lt;/span&gt; thrombosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Localized tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific for DVT; indicates <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> along the vein.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymmetrical calf swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common but not specific to DVT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythema and warmth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suggestive of <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain in the affected limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can occur with or without movement; can indicate <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilated <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May indicate <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> due to deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Homans' sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-specific; <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">Passive</span> forceful <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of the foot with extended knee will cause <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the calf.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mose’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painful response to gentle squeezing of the lower calf from side-to-side.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuhof's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thickening and deep <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the calf muscles upon palpation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phlegmasia <span class=\"customMeta\" data-dictid=\"455facf7ef169277718133da1f91e2\">Alba</span> Dolens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DVT of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> causes painful <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the leg with lymphangitis, which further increases <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (white leg).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phlegmasia Caerulea Dolens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensive <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> in <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> veins leading to a blue leg with possible <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> or infarction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is empyema thoracis treated?", "options": [{"label": "A", "text": "Antibiotics alone", "correct": false}, {"label": "B", "text": "Chest tube drainage and antibiotics", "correct": true}, {"label": "C", "text": "ICD alone", "correct": false}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "B. Chest tube drainage and antibiotics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presented with a history of stab injury to the arm. On examination, there was a hematoma, and radial and ulnar pulses were not felt. A 3.5cm longitudinal tear is noted in the brachial artery. Which among the following is the best treatment option?", "options": [{"label": "A", "text": "Primary repair with end-to-end anastomosis", "correct": false}, {"label": "B", "text": "Repair with great saphenous vein graft", "correct": true}, {"label": "C", "text": "Repair with prosthetic graft", "correct": false}, {"label": "D", "text": "Repair with saphenous vein patch", "correct": false}], "correct_answer": "B. Repair with great saphenous vein graft", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old female patient presents with pain in the thigh during walking. Investigation reveals the following finding as given below. What will be the best surgical management?", "options": [{"label": "A", "text": "PTA with stenting", "correct": false}, {"label": "B", "text": "Femoroiliac bypass", "correct": false}, {"label": "C", "text": "Aortofemoral bypass", "correct": true}, {"label": "D", "text": "Aorto-iliac bypass", "correct": false}], "correct_answer": "C. Aortofemoral bypass", "question_images": ["https://image.prepladder.com/notes/TmUYX8H4e9TQc2SqIJes1746448949.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the CEAP classification, What will be the stage in this patient as the patient presents with the same problem again and again?", "options": [{"label": "A", "text": "C2", "correct": true}, {"label": "B", "text": "C1", "correct": false}, {"label": "C", "text": "C4a", "correct": false}, {"label": "D", "text": "C5", "correct": false}], "correct_answer": "A. C2", "question_images": ["https://image.prepladder.com/notes/VzDCelp9U3o4wc4JjVvL1746450314.png"], "explanation_images": ["https://image.prepladder.com/notes/1ZUCZCmtfkgYn3uQHfjc1746450590.png", "https://image.prepladder.com/notes/ZvvC9ezAtzNnuoVMqw7Q1746450613.png", "https://image.prepladder.com/notes/8QEMB1r2PaXAKhyWIs3S1746450635.png", "https://image.prepladder.com/notes/0lCvsK707UiUeKEcc7L31746450673.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For<strong> clinical</strong> classification:</p>\n<ul>\n<li>No signs of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease</li>\n<li>Telangiectasia (&lt;1 mm) or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins ( 1-3 mm dilated veins)</li>\n<li>Varicose veins (&gt;3 mm )</li>\n<li><strong>Edema </strong></li>\n<li>Pigmentation or eczema</li>\n<li>LDS or atrophic blanche</li>\n<li>Corona phlebectatica</li>\n<li><strong>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></li>\n<li><strong>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</strong></li>\n</ul>\n<p> </p>\n<p>Clinical class can be further characterised as <strong>symptomatic </strong>(s), <strong>asymptomatic </strong>(a) or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> following previous successful treatment or <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> (r), e.g. C2a, C2s, C6r.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>C0</li>\n<li>C1 <strong>(Option B ruled out)</strong></li>\n<li>C2 <strong>(Option A)</strong></li>\n<li><strong>C3</strong></li>\n<li>C4a <strong>(Option C ruled out)</strong></li>\n<li>C4b</li>\n<li>C4c</li>\n<li><strong>C5 (Option D ruled out)</strong></li>\n<li><strong>C6</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <strong>etiological</strong> classification:</p>\n<ul>\n<li>Congenital</li>\n<li>Primary</li>\n<li>Secondary (post-thrombotic)</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> cause identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>Ec</li>\n<li>Ep</li>\n<li>Es</li>\n<li>En</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <strong>anatomical</strong> classification:</p>\n<ul>\n<li>Superficial veins</li>\n<li>Perforator veins</li>\n<li>Deep veins</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> location identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>As</li>\n<li>Ap</li>\n<li>Ad</li>\n<li>An</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <strong>pathophysiological </strong>classification:</p>\n<ul>\n<li>Reflux</li>\n<li>Obstruction</li>\n<li>Reflux and obstruction</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"19bbbcd51e16927771947c31adcdd0\">pathophysiology</span> identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>Pr</li>\n<li>Po</li>\n<li>Pr,o</li>\n<li>Pn</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate course of action for managing a 25-year-old male patient who was brought to the emergency room following a road traffic accident? The patient has a respiratory rate of 25 breaths per minute and a blood pressure of 80/45 mmHg. During examination, hyper-resonance is detected on the right side of the chest. Please refer to the provided chest X-ray for further evaluation.", "options": [{"label": "A", "text": "Wide bore needle insertion in the 5th intercostal space (ICS)", "correct": false}, {"label": "B", "text": "Wide bore needle insertion in the 5th ICS followed by an intercostal drain in the 5th ICS", "correct": true}, {"label": "C", "text": "Aspiration of the pleural fluid", "correct": false}, {"label": "D", "text": "No intervention is needed", "correct": false}], "correct_answer": "B. Wide bore needle insertion in the 5th ICS followed by an intercostal drain in the 5th ICS", "question_images": ["https://image.prepladder.com/content/v0ZklYG4rbNQ0ZtFwrts1745582384.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:743px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of pneumothoraces:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Spontaneous Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs<strong> without underlying lung disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> pleural blebs</li>\n<li>Seen commonly in smokers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple aspiration</li>\n<li>Thoracoscopy if recurrent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Spontaneous <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with <strong>pre-existing lung conditions </strong>(e.g., COPD)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More life-threatening due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> reserve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Thoracoscopy or pleurodesis, if needed</li>\n<li>Thoracoscopy with <span class=\"customMeta\" data-dictid=\"3b4c96c9d01692777199d56349e8d8\">stapling</span> of blebs and pleural <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> if surgery is contraindicated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Traumatic <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs during <strong>mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> or resuscitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> (from medical procedures)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"4be129c8311692777188780148e955\">hemopneumothorax</span> with dual chest tubes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Results from <strong>physical injury</strong> (blunt or penetrating)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive pressure in pleural space</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> compromise</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Emergency treatment with large bore needle <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> followed by thoracostomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A bus conductor was diagnosed with varicose veins. On examination, skin eczema and lipodermatosclerosis were noted. According to the CEAP classification system, he would be classified as:", "options": [{"label": "A", "text": "C1", "correct": false}, {"label": "B", "text": "C2", "correct": false}, {"label": "C", "text": "C3", "correct": false}, {"label": "D", "text": "C4", "correct": true}], "correct_answer": "D. C4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3Xwm1n6TJ9ZPwB9nGH841745583202.png", "https://image.prepladder.com/content/4OjyZVe5kXxwX8BRNC7g1745583202.png", "https://image.prepladder.com/content/caSWdmQlGm3wlO15nW6k1745583202.png", "https://image.prepladder.com/content/iAVInWp9xat3lrmTIzfo1745583202.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical classification:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No signs of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Telangiectasia (&lt;1 mm) or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins ( 1-3 mm dilated veins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varicose veins (&gt;3 mm )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Edema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>C4a - Pigmentation or eczema</li>\n<li>C4b - LDS or atrophic blanche</li>\n<li>C4c - Corona phlebectatica</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical class can be further characterised as <strong>symptomatic </strong>(s), <strong>asymptomatic </strong>(a) or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> following previous successful treatment or <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> (r), e.g. C2a, C2s, C6r.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiological classification:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ec</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ep</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Es</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secondary (post-thrombotic)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>En</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> cause identified</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anatomical classification:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>As</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ap</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perforator veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ad</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> location identified</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiological classification:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pr</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflux</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Po</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obstruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pr,o</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflux and obstruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pn</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"19bbbcd51e16927771947c31adcdd0\">pathophysiology</span> identified</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 35-year-old individual with a history of chronic smoking who is experiencing bluish discoloration of the toes and intermittent claudication, what would be the most suitable investigation to conduct next?", "options": [{"label": "A", "text": "CT Angiography", "correct": false}, {"label": "B", "text": "MR Angiography", "correct": false}, {"label": "C", "text": "Digital subtraction angiography", "correct": false}, {"label": "D", "text": "Duplex scan", "correct": true}], "correct_answer": "D. Duplex scan", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Comparison of investigative modalities for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arterial disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High resolution, 3D reconstruction, <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> detection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radiation exposure, contrast-related risks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MR angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No radiation, good soft tissue contrast</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Time-consuming, contraindicated in some patients (e.g., with <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> implants)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duplex ultrasonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-invasive, no radiation or contrast</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Operator-dependent, limited for deep arteries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ankle-Brachial Index</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Simple, non-invasive screening tool</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited specificity, affected by arterial calcification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": true}, {"label": "B", "text": "Primary Spontaneous Pneumothorax", "correct": false}, {"label": "C", "text": "Traumatic Pneumothorax", "correct": false}, {"label": "D", "text": "Bilateral Pneumothorax", "correct": false}], "correct_answer": "A. Tension pneumothorax", "question_images": ["https://image.prepladder.com/content/WjV4qIzZwOHcUtgAZN7Y1741111598.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tension Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma, mechanical ventilation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe dyspnea, hypotension, JVD, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> deviation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediastinal shift away from affected side, hyperlucency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ruptured <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> blebs (tall, thin males)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden dyspnea, pleuritic pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperlucency without <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traumatic Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt/penetrating trauma, rib fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea, pain, absent breath sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperlucency, no <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift unless tension develops</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, seen in severe trauma, barotrauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory distress, hypoxia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral hyperlucency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following adverse effects is not observed following a massive blood transfusion?", "options": [{"label": "A", "text": "Hypocalcemia", "correct": false}, {"label": "B", "text": "Hypercalcemia", "correct": true}, {"label": "C", "text": "Hypokalemia", "correct": false}, {"label": "D", "text": "Hyperkalemia", "correct": false}], "correct_answer": "B. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications of massive blood transfusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion of cold blood (stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms (coagulopathy) and worsening bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing haemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, increased risk of continued bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large volumes of transfused blood contain citrate, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypocalcemia leads to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypocalcemia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Packed red blood cells (PRBCs) and other blood products are preserved with <strong>citrate</strong>, an anticoagulant.</li>\n<li>Citrate binds to <strong>ionised calcium</strong> (Ca²⁺) in the recipient's blood, reducing the free <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> level - <strong>hypocalcemia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presents as muscle spasms, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, and decreased myocardial contractility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypokalemia</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium may shift intracellularly once transfused red blood cells are metabolically revived.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia, causing muscle weakness, paralysis, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased pH (alkalosis) can lead to muscle twitching, irritability, and impaired oxygen release from haemoglobin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leads to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid accumulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowered blood pH (acidosis) leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the recipient's immune response, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">Circulatory</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume of transfused blood exceeds the patient’s capacity to manage, leading to fluid overload.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary edema, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeated transfusions lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron deposits in organs (e.g., liver, heart, pancreas), lead to organ damage and failure over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABO or Rh incompatibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid destruction of red blood cells (hemolysis), causing fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to proteins in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood products are contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sepsis is characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man with IHD presents with sudden, severe, generalised abdominal pain and multiple episodes of vomiting. On examination, the pulse rate is 118 bpm, rhythm is irregularly irregular, and BP is 90/60 mmHg. The abdomen appears soft and non-distended, and bowel sounds are absent. Which of the following could be a likely diagnosis in this case?", "options": [{"label": "A", "text": "Acute severe pancreatitis", "correct": false}, {"label": "B", "text": "Ruptured aortic aneurysm", "correct": false}, {"label": "C", "text": "Acute mesenteric ischemia", "correct": true}, {"label": "D", "text": "Peptic ulcer perforation", "correct": false}], "correct_answer": "C. Acute mesenteric ischemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wJtFcqX8GTLgxITQWT1X1745479983.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute mesenteric ischemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden reduction in blood supply to the intestines, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and potential necrosis.</li>\n<li>Commonly involves the <strong>Superior mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (SMA).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pain:</strong> Severe, sudden-onset <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain disproportionate to physical findings.</li>\n<li><strong>Others:</strong> Nausea, vomiting, diarrhea, bloody stools, shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cardiovascular:</strong> Atrial fibrillation, recent MI, heart failure.</li>\n<li><strong>Vascular:</strong> Atherosclerosis, vasculitis.</li>\n<li><strong>Others:</strong> Hypercoagulable states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Angiography:</strong> Preferred <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool; reveals SMA occlusion, <strong>String of sausage sign</strong>, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall thickening, <span class=\"customMeta\" data-dictid=\"8b4d9f2762169277719595156f1088\">pneumatosis</span> intestinalis, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> gas.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"J. Jacobsen, Ulrik R Beierholm, R. Mikkelsen, F. Gustafsson, P. Alstrøm, N. Holstein-Rathlou\" data-hash=\"\" data-license=\"NA\" data-source='Figure 4 from \"Sausage-string\" appearance of arteries and arterioles can be caused by an instability of the blood vessel wall. | Semantic Scholar' data-tags=\"\" height=\"497\" src=\"https://image.prepladder.com/content/wJtFcqX8GTLgxITQWT1X1745479983.png\" width=\"641\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial:</strong> IV fluids, <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics, pain control.</li>\n<li><strong>Definitive:</strong> Anticoagulation (e.g., IV heparin), <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> embolectomy, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> resection. Vasodilators (e.g., papaverine) can be used intra-arterially to relieve vasospasm.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the management approach for a 50-year-old male patient who has a 40 mm abdominal aortic aneurysm detected during his routine annual checkup?", "options": [{"label": "A", "text": "Urgent endovascular aneurysm repair", "correct": false}, {"label": "B", "text": "Surgery is indicated if the aneurysmal diameter is &amp;gt; 55mm", "correct": true}, {"label": "C", "text": "Urgently wheel the patient to OT for surgery", "correct": false}, {"label": "D", "text": "Surgery is indicated only if the aneurysm is &amp;gt; 77mm", "correct": false}], "correct_answer": "B. Surgery is indicated if the aneurysmal diameter is &gt; 55mm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Surgery is indicated if the &lt;span class=\"customMeta\" data-dictid=\"4526cf250d169277718154d51cf55e\"&gt;aneurysmal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\"&gt;diameter&lt;/span&gt; is &amp;gt; 55mm:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Aortic <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> (AAA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Small <span class=\"customMeta\" data-dictid=\"53a624e24916927771804c93f567f7\">AAAs</span> (3.0–3.9 cm):</strong> Monitor every 2–3 years using ultrasound.</li>\n<li><strong>Medium <span class=\"customMeta\" data-dictid=\"53a624e24916927771804c93f567f7\">AAAs</span> (4.0–5.4 cm):</strong> Monitor every 6–12 months with ultrasound.</li>\n<li><strong>Large <span class=\"customMeta\" data-dictid=\"53a624e24916927771804c93f567f7\">AAAs</span> (≥5.5 cm): </strong>Surgical intervention recommended; if not, frequent <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> and clinical review.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factor Modification</strong>:</p>\n<ul>\n<li>Smoking Cessation</li>\n<li>Blood Pressure Control</li>\n<li>Cholesterol Management: <span class=\"customMeta\" data-dictid=\"2d286fa70b1692777199aba0434a49\">Statins</span> recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surgical Intervention (Option C &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I<strong>ndications for Surgery: </strong></p>\n<ul>\n<li><strong>Aneurysm <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">Diameter</span> ≥ 55 mm</strong> (High risk of rupture)</li>\n<li><strong>Rapid Growth: &gt; 5 mm</strong> increase in six months.</li>\n<li><strong>Symptomatic AAAs</strong>: Consider surgery.</li>\n</ul>\n<p><strong>Surgical Options</strong>:</p>\n<ul>\n<li><strong>Open <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Repair:</strong> Using a <span class=\"customMeta\" data-dictid=\"3b8daca52a16927771859646ba282e\">Dacron</span> graft, which is durable and has higher morbidity.</li>\n<li><strong>Endovascular <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> Repair (EVAR):</strong> Less invasive, requires long-term surveillance for complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding intermittent claudication is accurate?", "options": [{"label": "A", "text": "Felt at rest", "correct": false}, {"label": "B", "text": "Most commonly felt in the calf muscles", "correct": true}, {"label": "C", "text": "Day-to-day distance is variable", "correct": false}, {"label": "D", "text": "Relieved after getting out of bed", "correct": false}], "correct_answer": "B. Most commonly felt in the calf muscles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Most commonly felt in the calf muscles:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Boyd's <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</strong>:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade 0: Asymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No symptoms</strong> of claudication, even with exercise</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade I: Mild claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Able to walk more than <strong>200 meters</strong> (about 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade II: Moderate claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Able to walk between <strong>50 and 200 meters</strong> (about 160 to 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade III: Severe claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Able to walk <strong>less than 50 meters </strong>(about 160 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade IV: Ischemic rest pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain occurs at rest </strong>or with minimal exertion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 41-year-old female patient who presented with a twisted swelling on the scalp and face, accompanied by a pulsating sensation and a bruit heard during auscultation?", "options": [{"label": "A", "text": "Neurofibromatosis", "correct": false}, {"label": "B", "text": "Liposarcoma", "correct": false}, {"label": "C", "text": "Cirsoid Aneurysm", "correct": true}, {"label": "D", "text": "Varicocele", "correct": false}], "correct_answer": "C. Cirsoid Aneurysm", "question_images": ["https://image.prepladder.com/notes/94OoeJowq1G2l5i7ZUke1746432157.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"b7c89472071692777184f6f5df77f3\"&gt;Cirsoid&lt;/span&gt; Aneu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the TNM staging, a patient with lung cancer of size 2.5 cm is staged as:", "options": [{"label": "A", "text": "T1b", "correct": false}, {"label": "B", "text": "T1c", "correct": true}, {"label": "C", "text": "T2a", "correct": false}, {"label": "D", "text": "T1a", "correct": false}], "correct_answer": "B. T1c", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - T1c:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>AJCC 8TH Edition of <span class=\"customMeta\" data-dictid=\"d959e86070169277720092035c0155\">TNM</span> <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">Staging</span> of Lung Carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Tumor (T)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a(mi)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 1 cm <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 - 2 cm <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 - 3 cm</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involvement of the main <span class=\"customMeta\" data-dictid=\"8c78ae88d11692777183752131dce3\">bronchus</span> with the involvement of carina</li>\n<li>Involvement of visceral pleura</li>\n<li>Association with <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> or obstructive pneumonitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 - ≤4 cm <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 - ≤5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&gt; 5 - ≤7 cm OR</li>\n<li>Direct invasion of the Chest wall, <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">Phrenic</span> nerve, Pericardium, (Or)</li>\n<li>Satellite nodules in the same lobe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&gt; 7 cm in greatest dimension (Or)</li>\n<li>Any tumour with invasion of the mediastinum, diaphragm, heart, great vessels, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve, carina, trachea, oesophagus, spine (Or)</li>\n<li>Separate tumours in different lobes of the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> lung.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> (N)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"d54aac1d5516927771958b92a04d85\">peribronchial</span> and/or hilar nodes and <span class=\"customMeta\" data-dictid=\"65d8dfe7c616927771902cc9249bd7\">intrapulmonary</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> and/or <span class=\"customMeta\" data-dictid=\"b431f15ea816927771991371611d2f\">subcarinal</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contralateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> or hilar; ipsilateral/contralateral scalene/supraclavicular</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> (M)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor in <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> lung or pleural/pericardial nodule/malignant effusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> metastasis, including single non-regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> in one or more organs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of Thoracoscore?", "options": [{"label": "A", "text": "Performance status", "correct": false}, {"label": "B", "text": "Complication of surgery", "correct": true}, {"label": "C", "text": "ASA grading", "correct": false}, {"label": "D", "text": "Priority of surgery", "correct": false}], "correct_answer": "B. Complication of surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\"&gt;Complication&lt;/span&gt; of surg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 50-year-old male who is a long-term smoker and experiences pain in both thighs and buttocks while walking approximately 500 meters?", "options": [{"label": "A", "text": "Arterial disease involving the superficial femoral artery", "correct": false}, {"label": "B", "text": "Arterial disease with aortoiliac involvement", "correct": true}, {"label": "C", "text": "Femoral venous insufficiency", "correct": false}, {"label": "D", "text": "Arterial disease involving the profunda femoris artery", "correct": false}], "correct_answer": "B. Arterial disease with aortoiliac involvement", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vessels involved and common sites of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (in Atherosclerosis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Related Manifestations/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aorta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infrarenal aorta</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iliac arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> bifurcation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulse.</li>\n<li>Pain in the buttock is due to a block in the common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> or <strong>aortoiliac segment</strong> (30%), often associated with <span class=\"customMeta\" data-dictid=\"960bd9fb3d1692777189abb8d8f4cf\">impotence</span> and is called <strong>Leriche's syndrome.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Femoral artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calf claudication, absent popliteal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Popliteal artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adductor canal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calf and foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tibial arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal or mid-calf</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subclavian artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal subclavian</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arm ischemia, absent radial/ulnar pulses.</p>\n<p><strong><u>Subclavian steal syndrome:</u></strong></p>\n<p>Obstruction of the first part of the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> can cause reverse <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the vertebral artery, providing <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> to the arm but affecting the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> brain and upper limb, with steal being occult, partial, or complete.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brachial artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mid-humerus level</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forearm and hand ischemia, absent radial/ulnar pulses</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the appropriate course of action for managing a 25-year-old male patient who was brought to the emergency department after a road traffic accident (RTA)? The patient has a respiratory rate of 25 breaths per minute and a blood pressure of 80/45 mmHg. During examination, hyper-resonance is detected over the left side of the chest. The provided chest x-ray is shown below.", "options": [{"label": "A", "text": "Wide bore needle insertion in the right 5th ICS", "correct": false}, {"label": "B", "text": "Wide bore needle insertion in the left 5th ICS followed by an intercostal drain", "correct": true}, {"label": "C", "text": "Aspiration of the pleural fluid", "correct": false}, {"label": "D", "text": "No intervention is needed", "correct": false}], "correct_answer": "B. Wide bore needle insertion in the left 5th ICS followed by an intercostal drain", "question_images": ["https://image.prepladder.com/content/h1I8ia9RY9L36DjNKarW1746976251.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:743px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of pneumothoraces:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Spontaneous Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs<strong> without underlying lung disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> pleural blebs</li>\n<li>Seen commonly in smokers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple aspiration</li>\n<li>Thoracoscopy if recurrent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Spontaneous <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with <strong>pre-existing lung conditions </strong>(e.g., COPD)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More life-threatening due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> reserve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Thoracoscopy or <span class=\"customMeta\" data-dictid=\"8126bfda4a1692777195ede6823750\">pleurodesis</span> if needed</li>\n<li>Thoracoscopy with <span class=\"customMeta\" data-dictid=\"3b4c96c9d01692777199d56349e8d8\">stapling</span> of blebs and pleural <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> if surgery is contraindicated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Traumatic <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs during <strong>mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> or resuscitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> (from medical procedures)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"4be129c8311692777188780148e955\">hemopneumothorax</span> with dual chest tubes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Results from <strong>physical injury</strong> (blunt or penetrating)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive pressure in pleural space</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> compromise</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Emergency treatment with large bore needle <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> followed by thoracostomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After a road traffic accident, a patient was brought to the emergency department with chest injuries. The patient's respiratory rate is elevated at 44 breaths per minute, and their blood pressure is 90/40 mm/Hg. Although conscious, the patient can only speak single words. On examination, hyper-resonance is noted on the affected side of the chest. What would be your next immediate course of action?", "options": [{"label": "A", "text": "Intubate", "correct": false}, {"label": "B", "text": "Insert needle in appropriate intercostal space", "correct": true}, {"label": "C", "text": "Start intravenous fluids urgently", "correct": false}, {"label": "D", "text": "Take a chest X-ray", "correct": false}], "correct_answer": "B. Insert needle in appropriate intercostal space", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fsvIsx6iFAMSXnJhJVje1688041096.png"], "explanation": "<p>Correct Option B. \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 40-year-old woman who comes to the emergency room after a road traffic accident? She has a Glasgow Coma Scale score of 15/15, a heart rate of 110 beats per minute, a blood pressure of 90/60 mmHg, and an elevated jugular venous pressure. Percussion reveals hyper-resonance and decreased breath sounds in the right chest, while the left chest appears normal. However, the patient is experiencing difficulty breathing and there is bruising on the chest wall. The abdomen feels soft.", "options": [{"label": "A", "text": "Cardiac tamponade", "correct": false}, {"label": "B", "text": "Tension pneumothorax", "correct": true}, {"label": "C", "text": "Pericardial effusion", "correct": false}, {"label": "D", "text": "Massive hemothorax", "correct": false}], "correct_answer": "B. Tension pneumothorax", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yAsZTQ2pQsXcP2NZUonK1695534432.png", "https://image.prepladder.com/content/cc0Rg3Dv3J32GBdeU45J1695534440.png", "https://image.prepladder.com/content/3xZ3a9zis3KjSMLo53O71695534446.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old diabetic man presents with a progressive increase in pain in his calf. He now prefers to sleep in a seated position by hanging his leg to alleviate pain.Pain is more in the distal part like toes and feet. It gets aggravated with movements and pressure. The pain is increased in lying down and elevation of foot; it may be reduced on hanging the foot down. Which of the following is the most likely cause?", "options": [{"label": "A", "text": "Rest pain", "correct": true}, {"label": "B", "text": "Sciatica", "correct": false}, {"label": "C", "text": "Neurological claudication", "correct": false}, {"label": "D", "text": "Venous claudication", "correct": false}], "correct_answer": "A. Rest pain", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?", "options": [{"label": "A", "text": "Unfractionated heparin followed by warfarin", "correct": false}, {"label": "B", "text": "LMWH followed by oral anticoagulant", "correct": true}, {"label": "C", "text": "Catheter-directed thrombolysis", "correct": false}, {"label": "D", "text": "IVC filter placement", "correct": false}], "correct_answer": "B. LMWH followed by oral anticoagulant", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> with Duplex scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; detects <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> by impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and inability to <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> veins.</p>\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> material completely <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of vein</li>\n<li>Absence of compressibility</li>\n<li>Absence of blood flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venogram </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accurate for detecting and locating <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and differentiating <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> and non-occlusive <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> but less commonly used due to invasiveness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impedance Plethysmography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures changes in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> volume and flow using a cuff. Less useful for calf <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> and previous thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrin and <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Assays</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> products, including D-dimer.</p>\n<p>D-dimer has a high negative predictive value.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radioactive <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"7cd1a840a2169277719756692d362d\">radiolabeled</span> <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> to detect thrombus. Less commonly used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRVI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; Useful for <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> veins and IVC.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcutaneous LMWH: Rapidly anticoagulate confirmed <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> cases.</li>\n<li>Intravenous Unfractionated Heparin: For patients with significant <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>Fondaparinux or Bivalirudin: Alternatives for those with <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> sensitivity or heparin-induced thrombocytopenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transition to Oral Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duration: At least 3 months or longer based on risk factors or recurrence.</li>\n<li>Novel anticoagulants (NOACs): Rivaroxaban, <span class=\"customMeta\" data-dictid=\"bd0e99d93a169277718152523f2534\">Apixaban</span> (factor Xa inhibitors), Dabigatran (direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitor).</li>\n<li>Vitamin K Antagonists: <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">Warfarin</span> (alternative to NOACs).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heparin: <span class=\"customMeta\" data-dictid=\"0f61fd74c41692777180190320f12e\">Activated partial <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">thromboplastin</span> time</span> (APTT).</li>\n<li>Warfarin: INR maintained between 2.0 to 3.0.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Patients with contraindications to Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporary <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> Filter:</strong> Consider if <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk prevents <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> or to prevent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism. It does not treat the existing <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and is associated with long-term complications. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endovascular Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombus removal, lysis, and stenting.</li>\n<li>Beneficial in selected patients, especially those with <span class=\"customMeta\" data-dictid=\"dae3263b2716927771896cfc9f45c8\">iliofemoral</span> thrombosis, to reduce risk of chronic post-thrombotic syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic smoker presents with leg pain after walking 100 meters. On examination, there is an absent pulse in the bilateral dorsalis pedis, anterior tibial, and posterior tibial arteries, but no gangrene is noted. Intermittent claudication is suspected. Which of the following statements about this condition is correct?", "options": [{"label": "A", "text": "Pain is more at night and sleep", "correct": false}, {"label": "B", "text": "Pain aggravated by standing and relieved by bending forward", "correct": false}, {"label": "C", "text": "Development of pain on the 1st step of walking", "correct": false}, {"label": "D", "text": "Pain develops after walking some distance and is relieved by rest", "correct": true}], "correct_answer": "D. Pain develops after walking some distance and is relieved by rest", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Boyd's <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</strong>:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 0: Asymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No symptoms</strong> of claudication, even with exercise</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I: Mild claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk more than <strong>200 meters</strong> (about 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II: Moderate claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk between <strong>50 and 200 meters</strong> (about 160 to 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III: Severe claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk <strong>less than 50 meters </strong>(about 160 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV: Ischemic rest pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain occurs at rest</strong><strong> </strong>or with minimal exertion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of ulcer is given below?", "options": [{"label": "A", "text": "Venous ulcer", "correct": true}, {"label": "B", "text": "Arterial ulcer", "correct": false}, {"label": "C", "text": "Trophic ulcer", "correct": false}, {"label": "D", "text": "Diabetic foot", "correct": false}], "correct_answer": "A. Venous ulcer", "question_images": ["https://image.prepladder.com/content/nE6MUsYhgKh18ApjN4CP1724915971.png"], "explanation_images": ["https://image.prepladder.com/content/gM6Ebpp1mLmoh8dLr8Pj1724915995.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\"&gt;Venous&lt;/span&gt; u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate management for a patient presenting with constant chest pain and radiological findings of stanford type A aortic dissection?", "options": [{"label": "A", "text": "Surgical management", "correct": true}, {"label": "B", "text": "Vasodilator", "correct": false}, {"label": "C", "text": "Beta blocker", "correct": false}, {"label": "D", "text": "Beta blocker plus vasodilator", "correct": false}], "correct_answer": "A. Surgical management", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\"&gt;Surgical&lt;/span&gt; Manag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the outpatient department with a dilated, tortuous vein in the leg. The patient reported a history of trauma to the same area 10 years prior. Upon examination, a pulsatile vein was also noted. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Varicose vein", "correct": false}, {"label": "B", "text": "Angiofibroma", "correct": false}, {"label": "C", "text": "Hemangioma", "correct": false}, {"label": "D", "text": "A-V Fistula", "correct": true}], "correct_answer": "D. A-V Fistula", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9e0n1gjkltJwpaLRP9Uf1747292781.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Purpose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used for hemodialysis</li>\n<li>Provides high <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> for effective dialysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Site Selection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prefer <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> placement</li>\n<li>Non-dominant arm is typically used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arterial Quality</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires a strong arterial pulse for success</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vein Preservation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avoid placing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> lines in the arm intended for fistula</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man with a chronic history of IV drug use presents with progressively increasing swelling in the groin on the right side. The swelling is non-fluctuant but pulsatile on examination. He has diminished pulses distal to the swelling on the same side. What is the next step in the management of this patient?", "options": [{"label": "A", "text": "CT angiography followed by surgery", "correct": true}, {"label": "B", "text": "Oral antibiotics and observation", "correct": false}, {"label": "C", "text": "Compression stocking", "correct": false}, {"label": "D", "text": "Incision and drainage", "correct": false}], "correct_answer": "A. CT angiography followed by surgery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/taIQ1zqdfaw5482J4PAZ1747297635.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>True Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>False (Pseudoaneurysm)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves all three layers of the arterial wall.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves only a layer of <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue outside the vessel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wall Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intima, media, and <span class=\"customMeta\" data-dictid=\"a438935bda1692777180dfaf993677\">adventitia</span> are involved.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue surrounds the breach.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fusiform or saccular.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically spherical or ovoid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atherosclerosis, genetic conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trauma, surgery, or arterial puncture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> until complications arise.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often presents with a <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass or pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large arteries (e.g., aorta, iliac).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral arteries (e.g., femoral, popliteal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected by ultrasound, CT, and MRI.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected by <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical repair or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> techniques.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repair or <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> methods (e.g., <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> injection).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male presents to the emergency department after sustaining a stab wound to the right side of his chest. He is in acute distress, with a heart rate of 120 beats per minute, blood pressure of 90/60 mmHg, and respiratory rate of 28 breaths per minute. On physical examination, there are decreased breath sounds on the left side. A chest X-ray is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Pneumothorax", "correct": false}, {"label": "B", "text": "Hemothorax", "correct": true}, {"label": "C", "text": "Tension Pneumothorax", "correct": false}, {"label": "D", "text": "Hydrothorax", "correct": false}], "correct_answer": "B. Hemothorax", "question_images": ["https://image.prepladder.com/content/13o8nEqkuaFo8nObjzsU1717764507.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Hemoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with calf pain while walking a certain distance. The pain is severe enough that he must stop and rest before continuing. According to Boyd's grading, which of the following grades best describes this condition?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": true}, {"label": "D", "text": "Grade 4", "correct": false}], "correct_answer": "C. Grade 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Pain develops after walking a certain distance (claudication distance). The pain subsides due to increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> circulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Pain persists even while continuing to walk, but the patient can still walk with effort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient must stop and rest to relieve the pain; walking becomes significantly impaired.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient experiences rest pain, and the pain persists even at rest, indicating severe arterial disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presented with a history of stab injury over the arm. On examination, there was the presence of hematoma, and radial and ulnar pulses were not felt. A 3.5 cm longitudinal tear is noted in the brachial artery. Which of the following is the best treatment option?", "options": [{"label": "A", "text": "Primary repair with end-to-end anastomosis", "correct": false}, {"label": "B", "text": "Repair with great saphenous vein graft", "correct": true}, {"label": "C", "text": "Repair with prosthetic graft", "correct": false}, {"label": "D", "text": "Repair with saphenous vein patch", "correct": false}], "correct_answer": "B. Repair with great saphenous vein graft", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After undergoing surgery to correct a left-sided varicocele, a 30-year-old male patient inquires about the primary route through which venous drainage occurs following the surgery. How should the surgeon correctly respond to the patient's question?", "options": [{"label": "A", "text": "Cremasteric veins", "correct": true}, {"label": "B", "text": "Penile veins", "correct": false}, {"label": "C", "text": "Ectopic drainage in the iliac fossa", "correct": false}, {"label": "D", "text": "Testicular veins", "correct": false}], "correct_answer": "A. Cremasteric veins", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old male who had a road traffic accident and suffered from chest trauma was admitted to the ER. About 1800 ml of blood loss from the chest tube in an hour. What is the next step in management for this condition?", "options": [{"label": "A", "text": "Emergency Thoracotomy", "correct": true}, {"label": "B", "text": "Conservative for next 6-hours", "correct": false}, {"label": "C", "text": "Continue resuscitation", "correct": false}, {"label": "D", "text": "Wait &amp;amp; watch", "correct": false}], "correct_answer": "A. Emergency Thoracotomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Emergency Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with aortic dissection, injury to which of the following structure will cause hiccups?", "options": [{"label": "A", "text": "Phrenic nerve", "correct": true}, {"label": "B", "text": "Abdominal aorta", "correct": false}, {"label": "C", "text": "Thoracic aorta", "correct": false}, {"label": "D", "text": "Spinal accesory nerve", "correct": false}], "correct_answer": "A. Phrenic nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\"&gt;Phrenic&lt;/span&gt; nerve: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old patient presented with varicose veins. What is the investigation of choice for varicose veins?", "options": [{"label": "A", "text": "Duplex scan", "correct": true}, {"label": "B", "text": "Plethysmography", "correct": false}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "CT", "correct": false}], "correct_answer": "A. Duplex scan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Du\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with dull, aching pain and tortuous veins in both lower limbs. Which test would be appropriate for evaluating superficial femoral vein (SFJ) competence?", "options": [{"label": "A", "text": "Fegan's test", "correct": false}, {"label": "B", "text": "Homan’s test", "correct": false}, {"label": "C", "text": "Modified Perthes test", "correct": false}, {"label": "D", "text": "Brodie Trendelenburg test", "correct": true}], "correct_answer": "D. Brodie Trendelenburg test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0hENjxJowcabmPsgsjry1745931371.png", "https://image.prepladder.com/content/ilIH83DQpIYqiw153d301745931342.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old smoker presents with sudden, severe, tearing chest pain radiating to his back, shortness of breath, and mild nausea. His BP is 190/110 mmHg, and heart rate is 105 bpm. What is the initial management?", "options": [{"label": "A", "text": "Control blood pressure", "correct": true}, {"label": "B", "text": "Urgent surgery", "correct": false}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "Blood transfusion", "correct": false}], "correct_answer": "A. Control blood pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R2uQPzOEKRRxtDDDFmG01746171773.png", "https://image.prepladder.com/content/7yeYvcqOGBWqWi5x19tN1746171773.png", "https://image.prepladder.com/content/jYf66zaUMPMebbmmjqkR1746171808.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:726px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>It occurs when a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> or a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> occurs in the aorta, resulting in blood <span class=\"customMeta\" data-dictid=\"ebb0986d331692777200ab09e1b2e8\">tracking</span> into aortic tissues, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> layer, and creating a false lumen.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"552\" src=\"https://image.prepladder.com/content/R2uQPzOEKRRxtDDDFmG01746171773.png\" width=\"531\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden onset of severe, tearing chest, radiating to the <span class=\"customMeta\" data-dictid=\"3f66fcdaed169277719097d866e755\">interscapular</span> region</li>\n<li>Renal pain and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Paraplegia</li>\n<li>Syncope</li>\n<li>Weakness</li>\n<li>Hypotension or shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stable Patient: </strong>CT angiography<strong> </strong>is the standard investigation of choice.</li>\n<li><strong>Unstable Patients </strong>(SBP&lt;100 mm of HG, HR&gt;100 bpm)<strong>:</strong> TEE (TransEsophageal Echocardiography) (preferred investigation of choice)</li>\n<li>MRI can also be done if CT is unequivocal.</li>\n<li>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">x-ray</span> reveals widening of <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> along with left-sided pleural effusion</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Thielmann, Matthias &amp; Melzer, Andreas &amp; Benedik, Jaroslav &amp; Droc, Ionel &amp; Tsagakis, Konstantinos &amp; Dohle, Daniel &amp; Jakob, Heinz &amp; Abele, John.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/TEE-of-an-aortic-dissection-within-the-descending-part-indicates-the-flow-within-the_fig5_256075293\" data-tags=\"\" height=\"505\" src=\"https://image.prepladder.com/content/7yeYvcqOGBWqWi5x19tN1746171773.png\" width=\"703\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>TEE of an <span class=\"customMeta\" data-dictid=\"b95d9432b316927771811d2040b80c\">aortic dissection</span> within the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> part</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Management: </strong>Initial management of all types of <span class=\"customMeta\" data-dictid=\"b95d9432b316927771811d2040b80c\">aortic dissection</span> includes:</p>\n<ul>\n<li>Blood pressure control (which is usually high at presentation) <strong>(Option A)</strong></li>\n<li>Strict pain management,</li>\n<li>Prompt referral for specialist management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type A (or type I and II) dissections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B (or type III) dissections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Those involving the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> usually require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</p>\n<ul>\n<li>Synthetic <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> if needed</li>\n<li>Anastomosis</li>\n</ul>\n<p> </p>\n<p>Endovascular stenting of type A dissections.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial management: </strong></p>\n<ul>\n<li>Antihypertensive drugs</li>\n<li>Monitoring on an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> care unit</li>\n</ul>\n<p> </p>\n<p><strong>Complicated cases: </strong>If pain worsens, fails to resolve, or <span class=\"customMeta\" data-dictid=\"17038bf8a916927771917e8b246cfe\">malperfusion</span> signs appear (e.g., organ, limb, or neurological symptoms)</p>\n<ul>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> stents <strong> </strong></li>\n<li>Surgery (rarely used)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>DeBakey Classification</strong></p>\n<p>(Based on the pattern of dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> are involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stanford <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n<p>(Based on whether the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved in aortic dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type A </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> or both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes both Type I and Type II of DeBakey’s classification)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes Type III of DeBakey’s classification)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the least commonly used graft for coronary artery bypass graft (CABG)?", "options": [{"label": "A", "text": "Long saphenous vein", "correct": false}, {"label": "B", "text": "Internal mammary artery", "correct": false}, {"label": "C", "text": "Intercostal artery", "correct": true}, {"label": "D", "text": "Radial artery", "correct": false}], "correct_answer": "C. Intercostal artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ND9tbNnq5ebpc6zQFMmF1746169263.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are anterior mediastinal tumors except:", "options": [{"label": "A", "text": "Parathyroid adenoma", "correct": false}, {"label": "B", "text": "Lymphoma", "correct": true}, {"label": "C", "text": "Teratoma", "correct": false}, {"label": "D", "text": "Thymoma", "correct": false}], "correct_answer": "B. Lymphoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yt1wlbkNr4uopgyg8pci1746164987.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tumors of mediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior mediastinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Middle mediastinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior mediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thymomas <strong>(Option D ruled out)</strong></li>\n<li>Thymic carcinomas</li>\n<li>Thymic cyst</li>\n<li>Germ cell tumors <strong>(Option C ruled out)</strong></li>\n<li>Lymphomas</li>\n<li>Parathyroid adenomas <strong>(Option A ruled out)</strong></li>\n<li>Carcinoid tumour</li>\n<li>Fibroma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lymphomas<strong> (Option B)</strong></li>\n<li>Tumors of the heart and great vessels</li>\n<li>Tumours of the trachea, mainstem bronchi, and oesophagus</li>\n<li>Aortic pathologies such as aortic aneurysm, abscess, or dissection.</li>\n<li>Pericardial cysts</li>\n<li>Bronchogenic cysts</li>\n<li>Neuroenteric cyst</li>\n<li>Mesothelial cyst</li>\n<li>Pheochromocytoma</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neurilemomas (schwannomas)</li>\n<li>Neurofibromas</li>\n<li>Ganglioneuromas</li>\n<li>Ganglioneuroblastomas</li>\n<li>Neuroblastomas</li>\n<li>Pheochromocytomas</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old woman with no comorbidities presents with numbness and paraesthesia of the fingers along with the characteristic finding as shown in the image below. She has no history of smoking or history of other illnesses. She mentions the episodes occur when she is under excess stress or during cold temperatures. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Buerger’s disease", "correct": false}, {"label": "B", "text": "Atherosclerosis", "correct": false}, {"label": "C", "text": "Raynaud’s phenomenon", "correct": true}, {"label": "D", "text": "Giant cell arteritis", "correct": false}], "correct_answer": "C. Raynaud’s phenomenon", "question_images": ["https://image.prepladder.com/content/4VfFjsQorPcsvjxJ3e1O1746164862.png"], "explanation_images": ["https://image.prepladder.com/content/ZvRGQM5GpZXrLUWebDMq1746164905.png", "https://image.prepladder.com/content/kQSyqT94aMQGbcIeo13J1746164905.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterized by episodic reduction in blood flow, typically in the fingers, <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by cold exposure or stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pallor:</strong> Skin becomes pale or white due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow.</li>\n<li><strong>Cyanosis:</strong> Skin turns blue or purple due to <span class=\"customMeta\" data-dictid=\"2819f49f1a169277718587145c3004\">deoxygenation</span> of blood.</li>\n</ul>\n<ul>\n<li><strong>Rubor:</strong> Skin turns red as <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> returns, often with <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and tingling.</li>\n<li><strong>Cold Sensitivity:</strong> Cold, <span class=\"customMeta\" data-dictid=\"c1f2cd78a916927771936efc6a16cf\">numb</span> fingers.</li>\n<li><strong>Pain:</strong> Pain during the cyanotic phase.</li>\n</ul>\n<ul>\n<li><strong>Swelling and Tingling:</strong> Occurs in the <span class=\"customMeta\" data-dictid=\"04658981de1692777197ed1ff49228\">rubor</span> phase.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary Raynaud Phenomenon (Raynaud Disease):</strong>\n<ul>\n<li>Occurs without underlying disease.</li>\n<li>More common and has a better prognosis.</li>\n</ul>\n</li>\n<li><strong>Secondary Raynaud Phenomenon (Raynaud Syndrome):</strong>\n<ul>\n<li>Occurs due to an underlying condition (e.g., scleroderma, lupus).</li>\n<li>Often more severe.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lifestyle Modifications:</strong> Avoid cold exposure, stress reduction, and smoking cessation.</li>\n<li><strong>Medications:</strong> Calcium channel blockers (e.g., nifedipine), alpha-blockers (e.g., prazosin), and other vasodilators.</li>\n<li><strong>Avoidance of Triggers:</strong> Avoid cold, beta-blockers, and caffeine.</li>\n<li><strong>Advanced Treatments:</strong> Surgical <span class=\"customMeta\" data-dictid=\"1c33ea213b1692777199f5837fbe93\">sympathectomy</span> for severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Clinical Presentation and History:</strong> Based on symptoms and triggers.</li>\n<li><strong>Nailfold Capillaroscopy:</strong> To examine <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> changes.</li>\n<li><strong>Blood Tests:</strong> To identify underlying <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> or <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue diseases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with varicose veins complains of eczema in the same region. According to the CEAP guidelines, what is the stage of the clinical classification?", "options": [{"label": "A", "text": "C2", "correct": false}, {"label": "B", "text": "C3", "correct": false}, {"label": "C", "text": "C4a", "correct": true}, {"label": "D", "text": "C4b", "correct": false}], "correct_answer": "C. C4a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B3Gca73kLXwk1E4Qv2mf1745305324.png", "https://image.prepladder.com/content/aOicU3D144zUkAr1zlzO1745305324.png", "https://image.prepladder.com/content/lnNH7K6sfjO8qQpAOlMP1745305324.png", "https://image.prepladder.com/content/urb5bJ1YpovJkaaWbNrv1745305324.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Class</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>C0</td>\n<td>No visible or <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> signs of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease</td>\n</tr>\n<tr>\n<td>C1</td>\n<td>Telangiectasia or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins (&lt;1–3 mm)</td>\n</tr>\n<tr>\n<td>C2</td>\n<td>Varicose veins (&gt;3 mm)</td>\n</tr>\n<tr>\n<td>C3</td>\n<td>Edema without skin changes</td>\n</tr>\n<tr>\n<td>C4a</td>\n<td>Pigmentation or eczema</td>\n</tr>\n<tr>\n<td>C4b</td>\n<td>Lipodermatosclerosis (LDS) or <span class=\"customMeta\" data-dictid=\"b04fb2c703169277718295309e32d6\">atrophie</span> blanche</td>\n</tr>\n<tr>\n<td>C4c</td>\n<td>Corona phlebectatica</td>\n</tr>\n<tr>\n<td>C5</td>\n<td>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</td>\n</tr>\n<tr>\n<td>C6</td>\n<td>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Code</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Ec</td>\n<td>Congenital</td>\n</tr>\n<tr>\n<td>Ep</td>\n<td>Primary</td>\n</tr>\n<tr>\n<td>Es</td>\n<td>Secondary (e.g., post-thrombotic)</td>\n</tr>\n<tr>\n<td>En</td>\n<td>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> identified</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Code</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>As</td>\n<td>Superficial veins</td>\n</tr>\n<tr>\n<td>Ap</td>\n<td>Perforator veins</td>\n</tr>\n<tr>\n<td>Ad</td>\n<td>Deep veins</td>\n</tr>\n<tr>\n<td>An</td>\n<td>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> location identified</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Code</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Pr</td>\n<td>Reflux</td>\n</tr>\n<tr>\n<td>Po</td>\n<td>Obstruction</td>\n</tr>\n<tr>\n<td>Pr,o</td>\n<td>Reflux and obstruction</td>\n</tr>\n<tr>\n<td>Pn</td>\n<td>No identifiable pathology</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given condition:", "options": [{"label": "A", "text": "Venous ulcer", "correct": false}, {"label": "B", "text": "Malignant ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": false}, {"label": "D", "text": "Trophic ulcer", "correct": true}], "correct_answer": "D. Trophic ulcer", "question_images": ["https://image.prepladder.com/notes/K238cJWqWRh7VS9vTSkn1745916348.png"], "explanation_images": ["https://image.prepladder.com/content/KfqlW8GIA9Q5KyFGdAa31745304743.png", "https://image.prepladder.com/content/sL2kWqATCDyyCNIIAf5a1745304743.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:734px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Lesion Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Ischemic/Arterial</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Smoking, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Irregular edges, poor <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, dry necrotic base; round or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> with sharp demarcation</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Jonathan Moore\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Arterial_insufficiency_ulcer#/media/File:Arterial_ulcer_peripheral_vascular_disease.jpg\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/KfqlW8GIA9Q5KyFGdAa31745304743.png\" width=\"399\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Severe, particularly at night; relieved by dependency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Venous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Varicose veins, DVT, trauma, surgery, multiple pregnancies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Shallow, irregular/shaggy shape, granulating base, fibrinous material with moderate to heavy exudate</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nini00\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Venous_ulcer#/media/File:%C3%9Alceras_antes_da_cirurgia.JPG\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/sL2kWqATCDyyCNIIAf5a1745304743.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Mild; relieved by elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Neurotrophic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Numbness, paresthesias, burning, loss of sensation in the foot, DM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Punched-out, deep sinus, variable depth, partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> to severe, involving the tendon, fascia, joint capsule, or bone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Malignant Ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>History of skin cancer (e.g., <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> or <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Irregular, raised borders, ulcerating tumour with hard, <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Often painful, it can be associated with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or foul odour</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A construction worker presents to the OPD with complaints of white fingers. He has been working in the cement and concrete industry and has spent 20 years using heavy machinery drills and polishing wood and furniture. What is the most likely etiology for this condition?", "options": [{"label": "A", "text": "Candidal infection of the fingers due to continuous exposure to water", "correct": false}, {"label": "B", "text": "Exposure to thinners and paints", "correct": false}, {"label": "C", "text": "Continuous exposure to cement and concrete", "correct": false}, {"label": "D", "text": "Continuous exposure to drills and machines", "correct": true}], "correct_answer": "D. Continuous exposure to drills and machines", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a sudden onset of chest pain shooting to the neck and interscapular region. X-ray shows a widened mediastinum. Blood pressure is 110/90 mmHg in the right upper limb and 160/100 mmHg in the left upper limb. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute coronary syndrome", "correct": false}, {"label": "B", "text": "Acute pulmonary embolism", "correct": false}, {"label": "C", "text": "Acute aortic dissection", "correct": true}, {"label": "D", "text": "Esophageal rupture", "correct": false}], "correct_answer": "C. Acute aortic dissection", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/D9Db9f2BTTwFXSfiTtCb1745300436.png", "https://image.prepladder.com/content/42Ndr6zXip20fNTvKvqZ1745300436.png", "https://image.prepladder.com/content/frvbVcXEBLDn4vIjPDDi1745300436.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>DeBakey Classification</strong></p>\n<p style=\"text-align:center\">(Based on the pattern of dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> are involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stanford <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n<p style=\"text-align:center\">(Based on whether the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved in aortic dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type A </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> or both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes both Type I and Type II of DeBakey’s classification)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes Type III of DeBakey’s classification)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old patient presents with pain in the calf muscles while walking. The pain subsides with rest. Which of the following is not typically seen in intermittent claudication?", "options": [{"label": "A", "text": "Cramping in the muscles during exercise", "correct": false}, {"label": "B", "text": "Pain starting on taking the first step", "correct": true}, {"label": "C", "text": "The most common cause is atheroma", "correct": false}, {"label": "D", "text": "The level of occlusion cannot be decided based on symptoms", "correct": false}], "correct_answer": "B. Pain starting on taking the first step", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 0: Asymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No symptoms</strong> of claudication, even with exercise</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I: Mild claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk more than<strong> </strong><strong>200 meters</strong> (about 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II: Moderate claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk between <strong>50 and 200 meters</strong> (about 160 to 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III: Severe claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Able to walk <strong>less than 50 meters</strong> (about 160 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV: Ischemic rest pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain occurs at rest</strong> or with minimal exertion</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:501px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ABI / ABPI = <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP in the Ankle/ <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP in the arm</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Interpretation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">0.1 - 0.4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Critical limb ischemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 - 0.9</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Intermittent claudication</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1.0 - 1.2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 1.2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Calcified vessels (seen in patients with DM, End stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease)<strong> </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most preferred site for the insertion of the intercostal tube drain?", "options": [{"label": "A", "text": "Upper border of lower rib", "correct": true}, {"label": "B", "text": "Lower border of upper rib", "correct": false}, {"label": "C", "text": "Lower border of lower rib", "correct": false}, {"label": "D", "text": "Middle of intercostal space", "correct": false}], "correct_answer": "A. Upper border of lower rib", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Upper border of lower rib \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the distinguishing features between cardiac tamponade and tension pneumothorax ?", "options": [{"label": "A", "text": "Raised JVP", "correct": false}, {"label": "B", "text": "Breath sounds", "correct": true}, {"label": "C", "text": "Raised heart rate", "correct": false}, {"label": "D", "text": "Not improving after initial fluid resuscitation", "correct": false}], "correct_answer": "B. Breath sounds", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Breath sou\n<table border=\"1\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Cardiac Tamponade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Tension Pneumothorax</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Accumulation of fluid (blood or other) within the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> sac, compressing the heart.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Build-up of air in the pleural space, leading to lung collapse and <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Trauma, pericarditis, aortic dissection, myocardial infarction, etc.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Trauma, <span class=\"customMeta\" data-dictid=\"5b92d758801692777182d17f9d55bc\">barotrauma</span> (e.g., mechanical ventilation), lung disease, medical procedures, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Beck's triad: Hypotension, distended neck veins, muffled heart sounds.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Beck's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> is absent. Presents with <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> deviation, absent breath sounds, <span class=\"customMeta\" data-dictid=\"996c91641916927771893da6f18e6c\">hyperresonance</span> on percussion, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Hemodynamic Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output, <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">pulsus</span> paradoxus (exaggerated drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> during inspiration).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return, hypotension, and decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Echocardiography showing <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> with right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> collapse (\"swinging heart\").</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> showing <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift away from the affected side, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lung markings, and <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> lung.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Pericardiocentesis (draining fluid from the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> sac) is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Needle <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> followed by chest tube <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> (thoracostomy) to remove air from the pleural space.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given below device is :", "options": [{"label": "A", "text": "Pneumatic compression stocking", "correct": true}, {"label": "B", "text": "Elastic Compression Stockings", "correct": false}, {"label": "C", "text": "Vacuum assisted closure devices", "correct": false}, {"label": "D", "text": "Cellulites", "correct": false}], "correct_answer": "A. Pneumatic compression stocking", "question_images": ["https://image.prepladder.com/content/FrWqzDs3XyES4pGzkV5s1691495575.png"], "explanation_images": ["https://image.prepladder.com/content/u4tBxziplo6kqROI1v5F1713157212.png"], "explanation": "<p>Correct Option A - Pneumatic &lt;span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\"&gt;compression&lt;/span&gt; stocking\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pharmacological</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Early <span class=\"customMeta\" data-dictid=\"3243864c2316927771817341380a07\">Ambulation</span> (simplest method)</li>\n<li>Pneumatic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> Devices (MC used method)</li>\n<li>Sequential <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> devices </li>\n<li><img alt=\"\" data-author=\"\" data-license=\"\" data-source=\"\" height=\"273\" src=\"https://image.prepladder.com/content/u4tBxziplo6kqROI1v5F1713157212.png\" width=\"432\"/></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unfractionated Heparin</li>\n<li>LMWH (Low molecule weight Heparin)</li>\n</ul>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Preferred (Because monitoring is not needed)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presents to the emergency with a BP of 160/100 mmHg and a heart rate of 120 . CECT done reveals a Stanford A aortic dissection. What is the initial management of this given condition?", "options": [{"label": "A", "text": "Surgery", "correct": true}, {"label": "B", "text": "LMWH", "correct": false}, {"label": "C", "text": "Surgical repair", "correct": false}, {"label": "D", "text": "Vitamin K inhibitors", "correct": false}], "correct_answer": "A. Surgery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/J45JLYwZ43dAi8N7ukUp1713425599.png"], "explanation": "<p>Correct Option A - Surg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An abdominal aortic aneurysm is operated when its size is greater than ____?", "options": [{"label": "A", "text": "5 cm", "correct": false}, {"label": "B", "text": "6 cm", "correct": false}, {"label": "C", "text": "5.5 cm", "correct": true}, {"label": "D", "text": "6.5 cm", "correct": false}], "correct_answer": "C. 5.5 cm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 5.5 cm: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently encountered tumor in the mediastinum ?", "options": [{"label": "A", "text": "Thymoma", "correct": false}, {"label": "B", "text": "Neurogenic tumors", "correct": true}, {"label": "C", "text": "Lymphoma", "correct": false}, {"label": "D", "text": "Bronchial cyst", "correct": false}], "correct_answer": "B. Neurogenic tumors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Neurogenic tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion shown below?", "options": [{"label": "A", "text": "Wet gangrene", "correct": true}, {"label": "B", "text": "Dry gengrene", "correct": false}, {"label": "C", "text": "Frost bite", "correct": false}, {"label": "D", "text": "Ainhum", "correct": false}], "correct_answer": "A. Wet gangrene", "question_images": ["https://image.prepladder.com/content/Qwn8HpfclM8wl1lS49nj1713857061.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Wet gangrene: \n<table border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\"> </td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Dry Gangrene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Wet Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Ischemic <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of tissue due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood supply</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Necrosis of tissue with bacterial infection and excessive moisture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> (arterial insufficiency)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Infection (usually polymicrobial) in ischemic tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Dry, shriveled, and blackened tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Swollen, discolored (black, green, or brown), and moist tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Cold to touch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Warm to touch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Painless</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Can be painful</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Line of demarcation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Clear line between affected and healthy tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Indistinct or no clear line of <span class=\"customMeta\" data-dictid=\"6e26f8de1c1692777185d8f3885a0c\">demarcation</span> between affected and healthy tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Odor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Foul <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> due to bacterial infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Slow progression</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Rapid progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Surgical intervention (amputation) may be necessary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention and aggressive <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with early intervention</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> due to high risk of <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> complications</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed complication in a 29-year-old man who visits the outpatient department due to pain, heaviness, and swelling in his right leg? The patient has been dealing with varicose veins since he was 12 years old. After undergoing below-knee stripping of the long saphenous vein, both the symptoms and visible varicose veins disappeared.", "options": [{"label": "A", "text": "Hemorrhage", "correct": false}, {"label": "B", "text": "Thromboembolism", "correct": false}, {"label": "C", "text": "Neuralgia", "correct": true}, {"label": "D", "text": "Infection", "correct": false}], "correct_answer": "C. Neuralgia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neuralg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are indications for surgical intervention in abdominal aortic aneurysms ?", "options": [{"label": "A", "text": "Size more than 5.5 cm in males", "correct": false}, {"label": "B", "text": "Size more than 5 cm in females", "correct": false}, {"label": "C", "text": "Expansion of &amp;gt;0.5 cm within 6 months", "correct": false}, {"label": "D", "text": "All the above", "correct": true}], "correct_answer": "D. All the above", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - All the abov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which complication is seen after the Varicose vein stripping procedure ?", "options": [{"label": "A", "text": "Neuralgia", "correct": true}, {"label": "B", "text": "Deep vein thrombosis", "correct": false}, {"label": "C", "text": "Acrocyanosis", "correct": false}, {"label": "D", "text": "Telangiectasia", "correct": false}], "correct_answer": "A. Neuralgia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Neuralgia: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common anterior mediastinal tumour?", "options": [{"label": "A", "text": "Thymoma", "correct": true}, {"label": "B", "text": "Neurofibroma", "correct": false}, {"label": "C", "text": "Pericardial cyst", "correct": false}, {"label": "D", "text": "Bronchogenic cyst", "correct": false}], "correct_answer": "A. Thymoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Th\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Most common anterior <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> mass</strong></td>\n<td style=\"text-align:center\">Thymoma</td>\n</tr>\n<tr>\n<td><strong>Most common middle <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> mass</strong></td>\n<td style=\"text-align:center\">Pericardial cyst</td>\n</tr>\n<tr>\n<td><strong>Most common <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> mass</strong></td>\n<td style=\"text-align:center\">Neurogenic tumors</td>\n</tr>\n<tr>\n<td><strong>Overall most common <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> mass</strong></td>\n<td style=\"text-align:center\">Neurogenic tumors</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old chronic smoker presents with pain in his right leg. Upon examination, the pulse in the bilateral popliteal fossa is absent, and he experiences pain in the both buttock . Which level block is most likely present?", "options": [{"label": "A", "text": "Femoral artery Disease", "correct": false}, {"label": "B", "text": "Aortoiliac artery", "correct": true}, {"label": "C", "text": "Popliteal artery Disease", "correct": false}, {"label": "D", "text": "Iliac artery Disease", "correct": false}], "correct_answer": "B. Aortoiliac artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5e1cbaefc31692777181f98722a8f6\"&gt;Aortoiliac&lt;/span&gt; A\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Site of obstruction</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Manifestation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aorto-iliac disease</p>\n</td>\n<td>\n<p>Buttock, thigh, calf claudication</p>\n<p style=\"text-align: center;\">Leriche syndrome</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> → Impotence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Common <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> disease</p>\n</td>\n<td>\n<p>Thigh + Calf claudication</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Superficial <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> disease</p>\n</td>\n<td>\n<p>Calf claudication</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Popliteal disease</p>\n</td>\n<td>\n<p>Calf claudication</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Crural <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</p>\n</td>\n<td>\n<p>Calf claudication</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most commonly involved artery in pseudoaneurysm formation :", "options": [{"label": "A", "text": "Aorta", "correct": false}, {"label": "B", "text": "Femoral artery", "correct": true}, {"label": "C", "text": "Popliteal artery", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Femoral artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - F\n<table>\n<thead>\n<tr>\n<td> </td>\n<td>\n<p style=\"text-align:center\"><strong>Aneurysm</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Pseudoaneurysm</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n<td>\n<p>Permanent <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> or bulging of a <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> wall, typically involving all three layers (intima, media, and adventitia)</p>\n</td>\n<td>\n<p>A false <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> characterized by a breach in the arterial wall with blood contained by surrounding tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td>\n<p>Weakness in the arterial wall leading to <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and thinning of the vessel</p>\n</td>\n<td>\n<p>Partial <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> or leakage of the arterial wall resulting in a contained hematoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Causes</strong></p>\n</td>\n<td>\n<p>Atherosclerosis, genetic factors, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disorders, trauma, infections</p>\n</td>\n<td>\n<p>Trauma, <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> injury (e.g., <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedures), infection, arterial puncture</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Location</strong></p>\n</td>\n<td>\n<p>Can occur in various arteries, including the aorta, cerebral arteries, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> arteries, and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arteries</p>\n</td>\n<td>\n<p>Commonly associated with arteries accessible for <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedures, such as the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (groin), <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (wrist), or <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (arm)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Presentation</strong></p>\n</td>\n<td>\n<p>Often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> until <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> or <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of adjacent structures occurs</p>\n</td>\n<td>\n<p>Pulsatile mass, pain, tenderness, and <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the site; may be accompanied by other signs of arterial injury or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compromise</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Diagnosis</strong></p>\n</td>\n<td>\n<p>Imaging studies such as ultrasound, <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">computed tomography</span> (CT) scan, magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (MRI), or angiography</p>\n</td>\n<td>\n<p>Imaging studies, including ultrasound, <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> ultrasound, CT scan, or angiography; may require additional assessment to distinguish from true aneurysms</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Treatment</strong></p>\n</td>\n<td>\n<p>Depends on the size, location, and risk of rupture; options may include surveillance, medication, <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> repair, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention</p>\n</td>\n<td>\n<p>Treatment options depend on the size, location, and symptoms; can include observation, ultrasound-guided compression, <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> techniques, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On the 5 th postoperative day post CABG, the patient develops tachypnea and hypotension . What is the most probable cause?", "options": [{"label": "A", "text": "Sepsis", "correct": false}, {"label": "B", "text": "Acute kidney failure", "correct": false}, {"label": "C", "text": "Acute respiratory failure", "correct": true}, {"label": "D", "text": "Acute cardiac failure", "correct": false}], "correct_answer": "C. Acute respiratory failure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Acute &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;respiratory&lt;/span&gt; failu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While washing clothes in cold water, a female patient exhibits color changes in her hands from white to red . Which of the following drugs is best suited for this patient?", "options": [{"label": "A", "text": "ACE inhibitors", "correct": false}, {"label": "B", "text": "Calcium channel blockers", "correct": true}, {"label": "C", "text": "Thiazides", "correct": false}, {"label": "D", "text": "Alpha-blockers", "correct": false}], "correct_answer": "B. Calcium channel blockers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Calcium channel block\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following provides long-lasting results in a coronary artery bypass graft (CABG) ?", "options": [{"label": "A", "text": "Long saphenous vein", "correct": false}, {"label": "B", "text": "Internal mammary artery", "correct": true}, {"label": "C", "text": "Poly tetra fluoro eythlene (PTFE)", "correct": false}, {"label": "D", "text": "Gastroepiploic artery", "correct": false}], "correct_answer": "B. Internal mammary artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 75 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following paraneoplastic syndromes is NOT commonly associated with small cell lung carcinoma (SCLC)?", "options": [{"label": "A", "text": "Syndrome of Inappropriate Antidiuretic Hormone (SIADH)", "correct": false}, {"label": "B", "text": "Eaton-Lambert Syndrome", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": true}, {"label": "D", "text": "Cushing's Syndrome", "correct": false}], "correct_answer": "C. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lung Cancer Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Paraneoplastic Syndromes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Small Cell Lung Cancer (SCLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hyponatremia (SIADH) <strong>(Option A ruled out)</strong></li>\n<li>Ectopic <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> Production (Cushing-like syndrome) <strong>(Option D ruled out)</strong></li>\n<li>Eaton-Lambert Syndrome (common) <strong>(Option B ruled out)</strong></li>\n<li>Hypertrophic Osteoarthropathy</li>\n<li>Peripheral Neuropathy, Cerebellar Degeneration</li>\n<li>Thrombotic Events (occasionally)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Adenocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<ul>\n<li>Hypertrophic <span class=\"customMeta\" data-dictid=\"c8ca5837271692777194079a048ac0\">Osteoarthropathy</span> (1-10% of cases)</li>\n<li>Neurological and <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> Syndromes (rarely)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Squamous Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (SCC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hypercalcemia (frequent due to PTHrP)</li>\n<li>Thrombotic Events (e.g., Trousseau’s syndrome)</li>\n<li>Peripheral and central neuropathies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Across Lung Cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hematologic Syndromes (e.g., Thrombotic Events, <span class=\"customMeta\" data-dictid=\"340e5cd49c16927771917ee55b9e76\">Leukemoid</span> reactions, Pure red cell aplasia)</li>\n<li>Neurological and <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> Syndromes (e.g., <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">Peripheral</span> Neuropathy, Cerebellar Degeneration)</li>\n<li>Nonbacterial thrombotic (marantic) <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> (NBTE)</li>\n<li>Carcinoid syndrome</li>\n<li>Gynecomastia</li>\n<li>Acanthosis nigricans</li>\n<li>Erythema gyratum repens</li>\n<li>Nephrotic syndrome</li>\n<li>Hypouricemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZSS2u8CyZFu0Qla8AZbK1748765281.mp3", "video": ""}, {"text": "A 3-year-old child presents with a history of choking followed by intermittent coughing and wheezing. The X-ray is as follows. What is the most appropriate investigation for diagnosis and intervention?", "options": [{"label": "A", "text": "Chest X-ray", "correct": false}, {"label": "B", "text": "CT Scan", "correct": false}, {"label": "C", "text": "Rigid Bronchoscopy", "correct": true}, {"label": "D", "text": "Flexible Bronchoscopy", "correct": false}], "correct_answer": "C. Rigid Bronchoscopy", "question_images": ["https://image.prepladder.com/content/rVHIMKOBYaYlbTASewYn1739168588.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OmiSpnbLd1cfLuk1u7l51749130132.mp3", "video": ""}, {"text": "A 55 y/o male with a persistent cough and occasional chest discomfort has a chest X-ray showing a 2.5 cm peripheral, sharply demarcated, lobulated mass with a “popcorn” appearance. No smoking history. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pancoast Tumor", "correct": false}, {"label": "B", "text": "Pulmonary Hamartoma", "correct": true}, {"label": "C", "text": "Lung Abscess", "correct": false}, {"label": "D", "text": "Cystic Adenomatoid Malformation", "correct": false}], "correct_answer": "B. Pulmonary Hamartoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ivPt8ll0f1JEyAeuZ5fV1739171437.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PULMONARY HAMARTOMA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Most frequent <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumour of the lung.</li>\n<li>Consist of normal tissue elements containing mesothelial and endothelial elements in an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> location; <span class=\"customMeta\" data-dictid=\"2840cd55771692777194448139206d\">overgrowth</span> of cartilage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age &amp; Sex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>40 to 60 years.</li>\n<li>More common in males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Usually <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> and slow-growing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Imaging Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>CXR shows a 2 to 3-cm mass that is sharply demarcated and lobulated;\n\t\t\t\t<ul>\n<li>Usually not calcified</li>\n<li>“Popcorn” appearance is characteristic</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"Lange123\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Lung_nodule#/media/File:Thorax_pa_peripheres_Bronchialcarcinom_li_OF_markiert.jpg\" data-tags=\"\" height=\"476\" src=\"https://image.prepladder.com/content/ivPt8ll0f1JEyAeuZ5fV1739171437.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Excision of the lesion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Related Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"feb9e32e641692777180b0af007856\">adenomatoid</span> <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> in <strong>infants</strong> may represent <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> hamartomas <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1Hni7XvEiv48pTz0HZdw1748764356.mp3", "video": ""}, {"text": "A 45 y/o male with a 3-month history of cough, hemoptysis, and wheezing has a CXR showing a central mass obstructing the right bronchus. Biopsy reveals a low-grade malignant tumour diagnosed as bronchial adenoma. Which of the following is NOT a type of bronchial adenoma?", "options": [{"label": "A", "text": "Adenoid Cystic Carcinoma", "correct": false}, {"label": "B", "text": "Carcinoid", "correct": false}, {"label": "C", "text": "Small Cell Carcinoma", "correct": true}, {"label": "D", "text": "Mucoepidermoid Carcinoma", "correct": false}], "correct_answer": "C. Small Cell Carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>BRONCHIAL ADENOMA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tumours arising from bronchial <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> or glands are less aggressive than typical lung cancers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Carcinoids (85%):</strong> Low-grade, typical and <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> variants. <strong>(Option B ruled out)</strong></li>\n<li><strong>Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (ACC):</strong> Slow-growing, 10% of adenomas. <strong>(Option A ruled out)</strong></li>\n<li><strong>Mucous <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">Gland</span> Adenomas: </strong>Benign, arise from <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> glands.</li>\n<li><strong>Mucoepidermoid Carcinomas:</strong> 1-5% of adenomas, varying malignancy. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Central Lesions:</strong> Dyspnea, stridor, wheezing, cough, hemoptysis, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections.</li>\n<li><strong>Peripheral Lesions:</strong> Often asymptomatic, may be discovered incidentally.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest X-ray: Detects nodules or masses, central lesions best seen with an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> view</li>\n<li>CT Scan: Assesses tumor size, location, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> spread</li>\n<li>Bronchoscopy: Visualizes airways, allows biopsy</li>\n<li>MRI: Used when CT is unclear</li>\n<li>Octreotide Nuclear Scan: Detects <span class=\"customMeta\" data-dictid=\"2eaab075f416927771834adb276f1d\">carcinoid</span> tumors, <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> sites</li>\n<li>CT-Guided Fine-Needle Aspiration: For <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> nodules</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Surgical Resection: Main treatment</li>\n<li>Bronchoscopic Surgery: For small tumours; higher <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</li>\n<li>Open Lung Surgery/VATS: Preferred for complete removal, <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> parenchymal preservation</li>\n<li>Laser Ablation: Not recommended as primary treatment, used for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> tumours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The 5-year survival rate is <strong>96% </strong>following complete <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cptuTx8kgR4Sq8sDs3iW1748764476.mp3", "video": ""}, {"text": "A 65-y/o male, who worked for 30 years in shipbuilding, presents with a 6-month h/o progressive shortness of breath, chest pain, and significant weight loss. A CXR reveals a pleural effusion and a subsequent pleural biopsy confirms the diagnosis of malignant mesothelioma. Which subtype of malignant mesothelioma is most likely to be associated with a better prognosis in this patient?", "options": [{"label": "A", "text": "Sarcomatoid subtype", "correct": false}, {"label": "B", "text": "Epithelial subtype", "correct": true}, {"label": "C", "text": "Mixed (biphasic) subtype", "correct": false}, {"label": "D", "text": "Both B and C", "correct": false}], "correct_answer": "B. Epithelial subtype", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/id4ENeyCtsIGEDQcxh3Z1739172552.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>MALIGNANT MESOTHELIOMA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Highly aggressive <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> originating from pleural mesothelial cells, strongly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to asbestos.</li>\n<li>The most common primary pleural tumor.</li>\n</ul>\n<p><img alt=\"\" data-author=\"na\" data-hash=\"\" data-license=\"na\" data-source=\"na\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/id4ENeyCtsIGEDQcxh3Z1739172552.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Latency Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>15–40 years after <span class=\"customMeta\" data-dictid=\"92cc1e1acb1692777182aee908c1fd\">asbestos</span> exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Male predominance (2:1);</li>\n<li>Most common after age 40.</li>\n<li><strong>Asbestos exposure</strong> (occupational, familial): Commonly in industries like shipbuilding, brake pad manufacturing, and other asbestos-related manufacturing processes.</li>\n<li><strong>Secondary Exposure</strong>: Family members of workers exposed their clothes and belongings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types of Asbestos</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Serpentine fibres</strong> (less likely to cause mesothelioma)</li>\n<li><strong>Amphibole fibres</strong> (higher risk, especially crocidolite).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Histologic Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Epithelial:</strong> Better prognosis</li>\n<li><strong>Sarcomatoid:</strong> More aggressive <strong>(Option A ruled out)</strong></li>\n<li><strong>Mixed:</strong> Combination of both; Aggressive <strong>(Option C &amp; D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Dyspnea, chest pain, pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> in over 90% of cases, weight loss, fever.</li>\n<li><strong>Onset:</strong> Insidious, leading to late-stage diagnosis in most patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oXXhIZs7loYv2bovRHZy1748764664.mp3", "video": ""}, {"text": "A 65 y/o male with a 30-year history in brake pad manufacturing presents with dyspnea, chest discomfort, and cough. Imaging shows pleural thickening and nodules. Biopsy confirms early-stage malignant mesothelioma. Which IHC markers and treatments are most consistent with this diagnosis?", "options": [{"label": "A", "text": "Positive CEA, negative vimentin, treated with radiation therapy alone", "correct": false}, {"label": "B", "text": "Negative CEA, positive vimentin, treated with Extended Pleurectomy and Decortication (EPD) combined with chemotherapy", "correct": true}, {"label": "C", "text": "Positive CEA, negative cytokeratins, treated with chemotherapy only", "correct": false}, {"label": "D", "text": "Negative vimentin, positive cytokeratins, treated with Extrapleural Pneumonectomy (EPP) alone", "correct": false}], "correct_answer": "B. Negative CEA, positive vimentin, treated with Extended Pleurectomy and Decortication (EPD) combined with chemotherapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>MALIGNANT MESOTHELIOMA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Highly aggressive <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> originating from pleural mesothelial cells, strongly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to asbestos.</li>\n<li>The most common primary pleural tumour.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Imaging</strong>:\n\t\t\t\t<ul>\n<li>CXR, CT, MRI, FDG-PET: Assess tumour invasion and metastasis</li>\n<li>ECG: Checks for <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> involvement</li>\n</ul>\n</li>\n<li><strong>Biopsy</strong>:<strong> </strong>Pleural Biopsy: Via thoracoscopy, thoracentesis, or open techniques.</li>\n<li><strong>Immunhistochemistry findings:</strong></li>\n</ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:468px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mesothelioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adenocarcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">Antigen</span> (CEA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n<p><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vimentin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">Molecular Weight</span> Cytokines</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electron Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long, <span class=\"customMeta\" data-dictid=\"d1b46face11692777198b2a189803b\">sinuous</span> villi</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short, straight <span class=\"customMeta\" data-dictid=\"bbea63556f1692777202e8abdd66a4\">villi</span> with fuzzy glycocalyx</p>\n</td>\n</tr>\n</tbody>\n</table>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Staging</strong>: Based on tumour invasion (T), <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement (N), and <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (M).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Multimodality Therapy:</strong></p>\n<ul>\n<li>Early-stage: Surgery (EPP or EPD) with cisplatin-based <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> and radiotherapy.</li>\n<li>Advanced Disease: <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> may extend survival but not cure.</li>\n<li>Palliative Care: Pleural catheters, pleurodesis.</li>\n</ul>\n<p><strong>Surgical Options:</strong></p>\n<ul>\n<li>Extrapleural <span class=\"customMeta\" data-dictid=\"f2c4d4843f1692777196d0d8adf4db\">Pneumonectomy</span> (EPP): Complete lung resection; higher risk but more extensive.</li>\n<li>Extended <span class=\"customMeta\" data-dictid=\"ef0bf4fee016927771958a05647a4d\">Pleurectomy</span> and <span class=\"customMeta\" data-dictid=\"980a3fc15c1692777185d2c3e2e17f\">Decortication</span> (EPD): Lung-preserving, safer, preferred in many centres.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Median survival is 24–36 months depending on stage and treatment.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:468px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mesothelioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adenocarcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">Antigen</span> (CEA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n<p><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vimentin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">Molecular Weight</span> Cytokines</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electron Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long, <span class=\"customMeta\" data-dictid=\"d1b46face11692777198b2a189803b\">sinuous</span> villi</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short, straight <span class=\"customMeta\" data-dictid=\"bbea63556f1692777202e8abdd66a4\">villi</span> with fuzzy glycocalyx</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OI0VZqtwQ7qnx0mgHZH91745395954.mp3", "video": ""}, {"text": "What is the most common type of lung carcinoma?", "options": [{"label": "A", "text": "Small cell lung carcinoma", "correct": false}, {"label": "B", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "C", "text": "Adenocarcinoma", "correct": true}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "C. Adenocarcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0ncrT1Yr10ocjAee4b2f1739172810.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fohgDHmZck8nE6zMDBnV1748764813.mp3", "video": ""}, {"text": "A 60-year-old male, with a 40-year history of smoking, presents with a persistent cough, hoarseness, and recent onset of facial swelling and distended neck veins. Imaging reveals a mass in the central region of the right lung. Based on the location and clinical features, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Adenocarcinoma", "correct": false}, {"label": "B", "text": "Squamous Cell Carcinoma (SCC)", "correct": true}, {"label": "C", "text": "Large Cell Carcinoma", "correct": false}, {"label": "D", "text": "Apical (Pancoast's) Tumor", "correct": false}], "correct_answer": "B. Squamous Cell Carcinoma (SCC)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type of Lung Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tumor Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Adenocarcinoma</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> type (45% of lung cancers).</li>\n<li>Early metastasis, <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> involvement, <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> production, <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> differentiation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Peripheral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Squamous Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (SCC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Associated with smoking (90% of cases).</li>\n<li>Keratinization, <span class=\"customMeta\" data-dictid=\"021501f2831692777190ef9ba827fb\">intercellular</span> bridges, <span class=\"customMeta\" data-dictid=\"bcca1a959c16927771845f711facaf\">central necrosis</span> &amp; cavitation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Central</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Large Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Highly aggressive</li>\n<li>Undifferentiated, lacks specific features.</li>\n<li>Slow-growing, but highly vascular.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Peripheral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Small Cell <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">Neuroendocrine</span> Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Highly aggressive</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> to <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node,</li>\n<li>Neuroendocrine origin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Central</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Typical/Atypical Carcinoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Typical Carcinoids- <span class=\"customMeta\" data-dictid=\"2c27fdf0ed1692777190530a17c849\">Indolent</span> growth</li>\n<li>Atypical Carcinoids- Aggressive growth</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Varies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Apical (Pancoast's Tumors) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Invades <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> plexus</li>\n<li>Causes severe <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain.</li>\n<li>Pancoast’s syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Apical (Upper Lung)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/64ctrcpwqGSLaLuwXJJy1748764927.mp3", "video": ""}, {"text": "What is the most common site of metastasis for lung cancer?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Brain", "correct": true}, {"label": "C", "text": "Adrenal Glands", "correct": false}, {"label": "D", "text": "Bone", "correct": false}], "correct_answer": "B. Brain", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Lf2JJmGUjWsdVAG1GmgY1748765129.mp3", "video": ""}, {"text": "A 65 y/o woman presents to the emergency with a sudden onset of shortness of breath, chest pain, and hypotension. She is diagnosed with a massive pulmonary embolism. Which of the following is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Inferior Vena Cava (IVC) Filter", "correct": false}, {"label": "B", "text": "Thrombolytic Therapy", "correct": true}, {"label": "C", "text": "Ventilator Support", "correct": false}, {"label": "D", "text": "Vitamin K Antagonists", "correct": false}], "correct_answer": "B. Thrombolytic Therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BtFvPREm5wyaqkBTF00l1748763924.mp3", "video": ""}, {"text": "A 65 y/o male with a 35-pack-year smoking history presents with worsening dyspnea, cough, and weight loss. A CT shows a 6.5 cm right upper lobe mass invading the chest wall, with ipsilateral mediastinal lymph node involvement and liver metastasis as seen on the PET scan. What is the TNM stage of his lung cancer?", "options": [{"label": "A", "text": "T2b, N1, M0", "correct": false}, {"label": "B", "text": "T3, N2, M1b", "correct": true}, {"label": "C", "text": "T4, N2, M1a", "correct": false}, {"label": "D", "text": "T3, N3, M1c", "correct": false}], "correct_answer": "B. T3, N2, M1b", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<p><strong>AJCC 8TH EDITION OF <span class=\"customMeta\" data-dictid=\"d959e86070169277720092035c0155\">TNM</span> <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">STAGING</span> OF LUNG <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">CARCINOMA</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PRIMARY TUMOR (T)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1a(mi)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≤ 1 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 - 2 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 - 3 cm</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involvement of the main <span class=\"customMeta\" data-dictid=\"8c78ae88d11692777183752131dce3\">bronchus</span> with the involvement of carina</li>\n<li>Involvement of visceral pleura</li>\n<li>Association with <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> or obstructive pneumonitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 - ≤4 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 - ≤5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 5 - ≤7 cm OR</li>\n<li>Direct invasion of Chest wall, <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">Phrenic</span> nerve, <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">Pericardium</span> OR</li>\n<li>Satellite nodules in the same lobe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 7 cm in greatest dimension OR</li>\n<li>Any tumour with invasion of the mediastinum, diaphragm, heart, great vessels, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve, carina, trachea, oesophagus, spine OR</li>\n<li>Separate tumours in different lobes of the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> lung.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LYMPH <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">NODE</span> (N)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"d54aac1d5516927771958b92a04d85\">peribronchial</span> and/or hilar nodes and <span class=\"customMeta\" data-dictid=\"65d8dfe7c616927771902cc9249bd7\">intrapulmonary</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> and/or <span class=\"customMeta\" data-dictid=\"b431f15ea816927771991371611d2f\">subcarinal</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contralateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> or hilar; ipsilateral/contralateral scalene/supraclavicular</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DISTANT <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">METASTASIS</span> (M)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor in <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> lung or pleural/pericardial nodule/malignant effusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> metastasis, including single non-regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> in one or more organs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HYm9Eg0PmNCPfe1qrnBA1748765413.mp3", "video": ""}, {"text": "A 65 y/o male with a confirmed diagnosis of stage IIIB non-small cell lung cancer (NSCLC) is being evaluated for treatment options. His disease is localized with significant mediastinal lymph node involvement, and he has a good performance status. Which of the following is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Surgical resection followed by adjuvant chemotherapy", "correct": false}, {"label": "B", "text": "Chemoradiation followed by maintenance immunotherapy", "correct": true}, {"label": "C", "text": "Systemic therapy with palliative radiation", "correct": false}, {"label": "D", "text": "Adjuvant chemotherapy alone", "correct": false}], "correct_answer": "B. Chemoradiation followed by maintenance immunotherapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:484px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IA:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> only.</li>\n<li>No chemotherapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IB:</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical resection</li>\n<li>Adjuvant <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> if the tumour is greater than 4 cm. <strong>(Option A ruled out )</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IIA &amp; IIB:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery followed by <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> chemotherapy; <span class=\"customMeta\" data-dictid=\"8e55f41cc61692777191163ded2004\">lobectomy</span> is preferred.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IIIA (minimal N2 involvement):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemoradiation or surgery followed by <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> chemotherapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IIIB:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combined chemoradiation followed by maintenance <span class=\"customMeta\" data-dictid=\"2c003a40ea1692777189ec17568ab1\">immunotherapy</span> for 1 year.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic therapy with <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> radiation <strong>(Option C ruled out)</strong> including targeted therapy or <span class=\"customMeta\" data-dictid=\"2c003a40ea1692777189ec17568ab1\">immunotherapy</span> based on <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> status.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RZvQOZpaSLMEjcIHDMIQ1748766276.mp3", "video": ""}, {"text": "A 63-year-old man with a history of smoking presents with a central lung mass, weight loss, and a new diagnosis of squamous cell carcinoma (SCC). Which of the following is a common clinical presentation associated with squamous cell carcinoma of the lung due to its typical location?", "options": [{"label": "A", "text": "Pleural effusion causing dyspnea", "correct": false}, {"label": "B", "text": "Hypercalcemia with renal stones", "correct": false}, {"label": "C", "text": "Superior vena cava syndrome", "correct": true}, {"label": "D", "text": "Horner's syndrome", "correct": false}], "correct_answer": "C. Superior vena cava syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/j1a3KCeIKxIAFmXTBbwD1739173822.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Adenocarcinoma</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Squamous Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (SCC)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant epithelial tumours with <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> or <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> production.</li>\n<li>Includes acinar, papillary, <span class=\"customMeta\" data-dictid=\"68ecd7fcda16927771911cf53a388a\">lepidic</span> (bronchioloalveolar), and solid with <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> patterns, or a combination of these.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant epithelial tumour showing <span class=\"customMeta\" data-dictid=\"6f89b018b816927771908503daac75\">keratinization</span> and/or <span class=\"customMeta\" data-dictid=\"021501f2831692777190ef9ba827fb\">intercellular</span> bridges.</li>\n<li>Undergoes <span class=\"customMeta\" data-dictid=\"bcca1a959c16927771845f711facaf\">central necrosis</span> and cavitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most frequent lung cancer type, accounting for approximately 45% of cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs in approximately 30% of lung cancer patients; over 90% are cigarette smokers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clubbing, <span class=\"customMeta\" data-dictid=\"e4cbd4af34169277718043cb22ccb5\">Acanthosis</span> nigricans, thrombophlebitis, scar.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can present as Pancoast tumor, hypercalcemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> (75% of cases).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Centrally located and tend to expand against the bronchus, causing <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> compression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tends to <span class=\"customMeta\" data-dictid=\"c329085d1b1692777192eda410629f\">metastasize</span> earlier and more frequently to the central nervous system compared to SCC.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tends to <span class=\"customMeta\" data-dictid=\"c329085d1b1692777192eda410629f\">metastasize</span> later than adenocarcinoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management involves <span class=\"customMeta\" data-dictid=\"04f89c4775169277718128d3461838\">anatomic</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> for <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> tumours and a combination of <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection, ablation, and radiation for <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anatomical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> with a combination of chemoradiotherapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mt6USnZWOWc5kSzEwvf01748766400.mp3", "video": ""}, {"text": "A 62- y/o man with a history of heavy smoking is diagnosed with a central lung mass. He is also noted to have severe hypercalcemia and is receiving chemotherapy and radiation therapy. Which of the following statements is true?", "options": [{"label": "A", "text": "SCLC is less aggressive than large cell carcinoma", "correct": false}, {"label": "B", "text": "Oat cells are seen in Large cell carcinoma", "correct": false}, {"label": "C", "text": "SCLC is strongly linked to smoking and can cause SIADH", "correct": true}, {"label": "D", "text": "Large cell carcinoma usually presents in central lung areas", "correct": false}], "correct_answer": "C. SCLC is strongly linked to smoking and can cause SIADH", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small cell carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Large cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, oval-shaped cells,</p>\n<p>High nucleus-to-cytoplasm ratio, scant cytoplasm; often contains \"oat cells\"<strong>(Option B ruled out).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large cells with abundant cytoplasm, and prominent nucleoli.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly aggressive, rapid growth, early spread</p>\n<p><strong>(Option A ruled out).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less aggressive than SCLC, but still fast-growing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strongly associated with smoking.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significantly associated with smoking</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Central lung areas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peripheral lung areas<strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly responsive to <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> and chemotherapy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate response to treatment often requires surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor, due to early metastasis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Better than SCLC but still poor compared to other NSCLC types.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paraneoplastic syndromes, SIADH, Cushing’s. <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely associated with <span class=\"customMeta\" data-dictid=\"42825d622516927771943152da2670\">paraneoplastic</span> syndromes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/g9qKE43OGH6zfdlzLg2B1748766549.mp3", "video": ""}, {"text": "A 72 y/o woman presents with severe shoulder pain and noticeable ptosis. Imaging reveals a mass at the apex of the lung, involving the upper ribs and vertebrae. Horner’s syndrome is observed. Which imaging modalities are most suitable for the evaluation of this condition?", "options": [{"label": "A", "text": "Chest X-ray", "correct": false}, {"label": "B", "text": "Ultrasound", "correct": false}, {"label": "C", "text": "CT scan", "correct": false}, {"label": "D", "text": "MRI", "correct": true}], "correct_answer": "D. MRI", "question_images": [], "explanation_images": [], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li><li>↳ SRB’s Manual of Surgery. 6th edition. Pg.1112 Bailey and Love Short manual of surgery, pg no 1986 Schwartz 11th edition , pg no 680,698</li><li>↳ SRB’s Manual of Surgery. 6th edition. Pg.1112</li><li>↳ Bailey and Love Short manual of surgery, pg no 1986</li><li>↳ Schwartz 11th edition , pg no 680,698</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3XEPynedkqVKStLqaCKV1748766674.mp3", "video": ""}, {"text": "Which of the following statements regarding cardiac tumours is true?", "options": [{"label": "A", "text": "Angiosarcomas are the most common benign primary cardiac tumours.", "correct": false}, {"label": "B", "text": "Nearly 90% of primary cardiac tumours are malignant.", "correct": false}, {"label": "C", "text": "Myxomas are the most common primary cardiac tumours in adults.", "correct": true}, {"label": "D", "text": "Cardiac myocytes have high proliferative activity, contributing to the formation of cardiac tumours.", "correct": false}], "correct_answer": "C. Myxomas are the most common primary cardiac tumours in adults.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumour Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Myxoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common primary <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tumour- accounts for over 50% of cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rhabdomyoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in infants and children, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> sclerosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Angiosarcoma (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> primary <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tumour.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5UIJL05ByhrtHgUVyY7a1748766821.mp3", "video": ""}, {"text": "A 55 y/o female presents with symptoms of shortness of breath, occasional dizziness, and a recent episode of fever and weight loss. Imaging studies reveal a mass in the left atrium and is diagnosed with atrial myxoma. Which of the following is true?", "options": [{"label": "A", "text": "The majority of atrial myxomas arise from the right atrium.", "correct": false}, {"label": "B", "text": "Atrial myxomas are more common in males, around 3rd decade of life.", "correct": false}, {"label": "C", "text": "Atrial myxomas can cause systemic emboli and obstruction of blood flow.", "correct": true}, {"label": "D", "text": "The genetic cause of atrial myxomas is always linked to an autosomal recessive pattern.", "correct": false}], "correct_answer": "C. Atrial myxomas can cause systemic emboli and obstruction of blood flow.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DhCRiLBgPpal88nT0oPU1748767001.mp3", "video": ""}, {"text": "A 14 y/o boy presents with a chest wall deformity characterized by a protruding sternum, resulting in a convex appearance of the chest. The patient is otherwise asymptomatic, and his chest wall growth is nearing completion. Which of the following statements about the management of this condition is true?", "options": [{"label": "A", "text": "The Nuss procedure is the preferred surgical approach.", "correct": false}, {"label": "B", "text": "Non-surgical bracing is effective in correcting pectus carinatum", "correct": false}, {"label": "C", "text": "The modified Ravitch procedure is exclusively used for treating the Pigeon chest.", "correct": false}, {"label": "D", "text": "Surgical intervention for pectus carinatum is typically recommended for cosmetic reasons.", "correct": true}], "correct_answer": "D. Surgical intervention for pectus carinatum is typically recommended for cosmetic reasons.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KmTvOOWUM4qX0QHmUBef1739182783.png", "https://image.prepladder.com/content/wPjClMEx5jILXdf2rSKI1739182883.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eQ2ZpyqHf9OEr2hZwz6o1748767245.mp3", "video": ""}, {"text": "The thoracic duct, the largest lymphatic vessel in the body, passes through the posterior mediastinum. Which of the following anatomical triangles is the key area used for locating and managing the thoracic duct?", "options": [{"label": "A", "text": "Simon's triangle", "correct": false}, {"label": "B", "text": "Lesgaft's triangle", "correct": false}, {"label": "C", "text": "The triangle of Petit", "correct": false}, {"label": "D", "text": "Poirier’s Triangle", "correct": true}], "correct_answer": "D. Poirier’s Triangle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EIsiLa9dlVCVM7H2VKtP1739161977.png", "https://image.prepladder.com/content/HLMo56eiasbekDqBEetR1739162045.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4RQh5IpBseLFmGV3uCgl1748762387.mp3", "video": ""}, {"text": "A 48 y/o female presents with fluctuating muscle weakness, difficulty speaking, and drooping eyelids that worsen with physical activity. Imaging reveals a mass in the anterior mediastinum. Which of the following is the most likely paraneoplastic syndrome associated with her condition?", "options": [{"label": "A", "text": "Lambert-Eaton myasthenic syndrome", "correct": false}, {"label": "B", "text": "Myasthenia gravis", "correct": true}, {"label": "C", "text": "Cushing syndrome", "correct": false}, {"label": "D", "text": "Syndrome of inappropriate antidiuretic hormone (SIADH)", "correct": false}], "correct_answer": "B. Myasthenia gravis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/c8AIVS2gZ3GrTaNNyBWK1739159439.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/x5HzskV4MdrtlhrjSgOx1748761105.mp3", "video": ""}, {"text": "A 55 y/o male presents with a persistent cough and dyspnea on exertion. A chest x-ray reveals an anterior mediastinal mass with tracheal deviation. What is the next best step in evaluating this patient for a potential thymoma?", "options": [{"label": "A", "text": "Serum markers", "correct": false}, {"label": "B", "text": "Chest X-ray with lateral view", "correct": false}, {"label": "C", "text": "Contrast-enhanced CT scan", "correct": true}, {"label": "D", "text": "Pulmonary function tests (PFTs)", "correct": false}], "correct_answer": "C. Contrast-enhanced CT scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zIyDxu17OylteE9FPscQ1739159844.png", "https://image.prepladder.com/content/ZEVzAXoMl735yJZ69i6W1739159975.png", "https://image.prepladder.com/content/uRN78IBi753le3MtgaVa1739160079.png", "https://image.prepladder.com/content/RpmLPB838oQJjPIlpHXp1739160256.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nclWaBoonPqtzWM4iCp51748761238.mp3", "video": ""}, {"text": "A 63 y/o female is diagnosed with a Stage III thymoma and presents with symptoms of myasthenia gravis. The tumour appears to have invaded the superior vena cava and pericardium. What is the most appropriate treatment plan for this patient?", "options": [{"label": "A", "text": "Complete surgical resection", "correct": true}, {"label": "B", "text": "Radiation therapy alone", "correct": false}, {"label": "C", "text": "Observation and periodic follow-up imaging", "correct": false}, {"label": "D", "text": "Chemotherapy as a primary treatment without surgery", "correct": false}], "correct_answer": "A. Complete surgical resection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Masaoka-Koga <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">Staging</span> System</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The tumour is completely encapsulated, meaning it is confined within the <span class=\"customMeta\" data-dictid=\"fbd2788fff16927772009c0137de78\">thymus</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and has not spread beyond its capsule.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The tumour has spread beyond the <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> of the thymus.</p>\n<p>Microscopic or <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> invasion into the surrounding <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> tissue or <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> pleura.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The tumour has spread to adjacent organs in the chest, such as the pericardium, the lungs, or the <span class=\"customMeta\" data-dictid=\"fa1831d5c016927771886f0447bc65\">great vessels</span> (aorta, <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The tumour has spread to distant sites in the body.</p>\n<ul>\n<li><strong>Stage IVa</strong>: Spread to the <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> or pleura</li>\n<li><strong>Stage IVb</strong>: Spread to distant organs through the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> or <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> system.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ckS8HcVhrEP4kIMo8mS01748761339.mp3", "video": ""}, {"text": "A 48 y/o man with a history of pulmonary TB presents with progressive shortness of breath, facial swelling, and difficulty swallowing. His chest X-ray shows an abnormal shadow in the mediastinum. A CT scan reveals extensive fibrotic tissue compressing the SVC and oesophagus. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Superior vena cava syndrome", "correct": false}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Chronic fibrous mediastinitis", "correct": true}, {"label": "D", "text": "Thymoma", "correct": false}], "correct_answer": "C. Chronic fibrous mediastinitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/unxmXnsbTu0RyZTl8kLq1748761441.mp3", "video": ""}, {"text": "A 72-year-old male with COPD presents with sudden severe shortness of breath and right-sided chest pain. On examination, he is cyanotic, in respiratory distress, and has diminished breath sounds on the right side. A CXR shows a large air collection in the right pleural space. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary Spontaneous Pneumothorax (PSP)", "correct": false}, {"label": "B", "text": "Secondary Spontaneous Pneumothorax (SSP)", "correct": true}, {"label": "C", "text": "Chylothorax", "correct": false}, {"label": "D", "text": "Hemothorax", "correct": false}], "correct_answer": "B. Secondary Spontaneous Pneumothorax (SSP)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1BGPUJSCJgHLjiNX8RKD1739160914.png", "https://image.prepladder.com/content/XJAu0ePr9biYBQtjzinb1739160978.png", "https://image.prepladder.com/content/xjlHJuAb5SL9py9v6AFh1739161049.png", "https://image.prepladder.com/content/9GINzLRdMWtDrzd1SxkH1739161161.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Spontaneous</strong></p>\n<p><strong>Pneumothorax (PSP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Secondary Spontaneous</strong></p>\n<p><strong>Pneumothorax (SSP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<ul>\n<li>Occurs without underlying lung disease. (Option A)</li>\n<li>Typically affects young individuals (under 35 years)</li>\n<li>It arises from the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of small blebs or cysts on the lung surface, leading to air entering the pleural space.</li>\n</ul>\n<p>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Occurs in individuals with existing lung pathology.</li>\n<li>More common in older adults (typically over 45 years).</li>\n<li>Recurrence rates are higher compared to PSP, with up to 80% of patients experiencing additional episodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Male sex</li>\n<li>Tall and thin body type</li>\n<li>Smoking</li>\n<li>Family history of pneumothorax</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease (COPD)</li>\n<li>Cystic fibrosis</li>\n<li>Tuberculosis</li>\n<li>Lung cancer</li>\n<li>Other lung diseases (e.g., asthma, sarcoidosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Sudden onset of chest pain</li>\n<li>Mild to moderate dyspnea</li>\n<li>Rarely life-threatening</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Severe dyspnea</li>\n<li>Hypoxemia and hypercapnia</li>\n<li>Chest pain</li>\n<li>Potential for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest X-ray</li>\n<li>CT scan may be used for confirmation in some cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest X-ray</li>\n<li>CT scan for <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">differential</span> diagnosis, especially in <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Observation for small, <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> cases.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for larger cases.</li>\n<li>Chest tube placement if <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> fails.</li>\n<li>Surgical options (VATS, pleurodesis) for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> cases.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hospital admission for monitoring.</li>\n<li>Chest tube placement for large or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> cases.</li>\n<li>Surgical intervention based on underlying disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> of Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT of Pneumothorax</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<img alt=\"\" data-author=\"Karthik Easvur\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pneumothorax_gif_1.gif\" data-tags=\"\" height=\"424\" src=\"https://image.prepladder.com/content/1BGPUJSCJgHLjiNX8RKD1739160914.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p><img alt=\"\" data-author=\"en:User:Clinical Cases\" data-hash=\"\" data-license=\"CC BY-SA 2.5 \" data-source=\"https://commons.wikimedia.org/wiki/File:Pneumothorax_CT.jpg\" data-tags=\"\" height=\"412\" src=\"https://image.prepladder.com/content/XJAu0ePr9biYBQtjzinb1739160978.png\" width=\"570\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YMS5vsJ3jHIDHlsY5NHf1748761610.mp3", "video": ""}, {"text": "A 30-year-old male presents to the emergency department after a stabbing injury to the chest, having respiratory distress, 4 cm wound on the right side. On examination, his breath sounds are decreased on the right side, and he shows signs of hypoxia. His vital signs are stable. What is the most appropriate first step in managing this patient?", "options": [{"label": "A", "text": "Perform needle thoracocentesis in the 2nd intercostal space, midclavicular line", "correct": false}, {"label": "B", "text": "Insert a chest tube immediately at the site of the injury", "correct": false}, {"label": "C", "text": "Apply a sterile occlusive dressing over the wound, taped on three sides", "correct": true}, {"label": "D", "text": "Obtain a chest X-ray to assess the injury and confirm the diagnosis", "correct": false}], "correct_answer": "C. Apply a sterile occlusive dressing over the wound, taped on three sides", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dFXuf8jjGfh1I2VqSfIp1739161303.png", "https://image.prepladder.com/content/vi6auhGAUONS5miw3NmE1739161373.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>OPEN PNEUMOTHORAX</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Large <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> (&gt;3 cm).</li>\n<li>Intrathoracic pressure = Atmospheric pressure.</li>\n<li>If the size of the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> &gt; 2/3rds of the trachea’s diameter, the air is drawn through the wound rather than the trachea, leading to air accumulation in the hemithorax, hypoventilation, and hypoxia.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/vi6auhGAUONS5miw3NmE1739161373.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Seal the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> </strong>with a<strong> </strong>sterile <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> plastic <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> (e.g., OPSITE™) taped on three sides to create a <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> valve.</li>\n<li><strong>Chest Tube Placement: </strong>Insert a chest tube as soon as possible at a site distant from the injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Potential Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tension Pneumothorax</strong> if the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> creates a one-way <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> effect.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s2rfkpxcCnkZR7b0odlb1748761780.mp3", "video": ""}, {"text": "A 25-year-old male, after a motor vehicle accident, presents with severe respiratory distress, decreased breath sounds on the right, hyper-resonance, and tracheal deviation to the left. His BP is 85/55 mmHg, and jugular veins are distended. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Order an urgent chest X-ray to confirm the diagnosis", "correct": false}, {"label": "B", "text": "Perform an immediate needle thoracocentesis in the 5th intercostal space, in anterior axillary line", "correct": true}, {"label": "C", "text": "Insert a chest tube into the 5th intercostal space in the anterior axillary line", "correct": false}, {"label": "D", "text": "Perform a finger thoracostomy in the safe triangle", "correct": false}], "correct_answer": "B. Perform an immediate needle thoracocentesis in the 5th intercostal space, in anterior axillary line", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eYzS5BfODw1FZzlHZoSp1739161528.png", "https://image.prepladder.com/content/zo5t9gc1Yvzl65b2SkbA1739161593.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>TENSION PNEUMOTHORAX</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>D/t<strong> ‘one-way valve’</strong> air leaks from the lung or chest wall.</li>\n<li>Air is sucked into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> without any escape, collapsing and compressing the affected lung.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> shifts to the opposite side, reducing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return and compressing the opposite lung, leading to decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and function. This can result in sudden death.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/eYzS5BfODw1FZzlHZoSp1739161528.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Penetrating Chest Trauma.</li>\n<li>Blunt Chest Trauma with parenchymal lung injury and persistent air leak.</li>\n<li>Iatrogenic Lung Injury (e.g., central venepuncture)</li>\n<li>Mechanical Positive-Pressure Ventilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tachypnea and Tachycardia</li>\n<li>Hyper-resonance and Decreased/Absent Breath Sounds</li>\n<li>Resonant Percussion with severe mediastinal/tracheal shift</li>\n<li>Cyanosis and Hypotension</li>\n<li>Chest Pain</li>\n<li>Distended Neck Veins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Emergency Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> is a <span class=\"customMeta\" data-dictid=\"dd729c897216927771845c2b95f211\">clinical diagnosis</span> and treatment should never be delayed by waiting for radiological confirmation.</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"367e80b0381692777200c1327c5238\">Thoracocentesis</span> (needle): Wide bore needle (typically a 20- or 22-gauge) in the 5nd <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the safety triangle.</li>\n<li>Decompression should be performed in the \"safe triangle.\"</li>\n</ul>\n<ul>\n<li><strong>Safe <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> Boundaries</strong>:\n\n\t\t\t\t<ul>\n<li>Posterior: Latissimus dorsi</li>\n<li>Anterior: Lateral border of the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major</li>\n<li>Inferior: A line drawn perpendicularly from the <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> to the back, just <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the mid-axillary line.</li>\n</ul>\n</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/zo5t9gc1Yvzl65b2SkbA1739161593.png\" width=\"300\"/>\n<ul>\n<li>In critical situations, a finger <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> can be done in the same location.</li>\n</ul>\n<ul>\n<li>Nasal Oxygen for support.</li>\n<li>Intercostal Tube Placement (ICT) once stable and confirmed by chest X-ray.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Care </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Antibiotics and analgesics for treatment.</li>\n<li>Ventilator Support with IPPV in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cFZ6vy4lBAQD4pVXYWez1748762071.mp3", "video": ""}, {"text": "A 70 y/o woman with lung cancer presents with sudden severe chest pain and shortness of breath, 3 weeks post-lobectomy. She is pale, tachypneic, with BP 85/50 mmHg and HR 120 bpm. Examination reveals right-sided dullness and diminished breath sounds. A CXR shows a large pleural effusion, and thoracentesis drains 1000ml of blood. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Observation and follow-up with chest X-ray", "correct": false}, {"label": "B", "text": "Immediate administration of intravenous fluids and blood products", "correct": false}, {"label": "C", "text": "Thoracotomy with evacuation and lung decortication", "correct": false}, {"label": "D", "text": "Intercostal chest tube (ICT) placement", "correct": true}], "correct_answer": "D. Intercostal chest tube (ICT) placement", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/c1Mih5qSx2OqC0k0ebLA1739161756.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>HEMOTHORAX</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The presence of blood in the pleural cavity, causes irritation, pain, and potential shock.</p>\n<p><img alt=\"\" data-author=\"Amadalvarez\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hemot%C3%B2raxD.1280.jpg\" data-tags=\"\" height=\"297\" src=\"https://image.prepladder.com/content/c1Mih5qSx2OqC0k0ebLA1739161756.png\" width=\"300\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Trauma (e.g., rib fractures)</li>\n<li>Postoperative complications (e.g., lung, cardiac, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> surgeries)</li>\n<li>Tumours (lung, mediastinum, pleura)</li>\n<li>Leaking aneurysms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest pain and tenderness</li>\n<li>Dyspnea</li>\n<li>Dullness on percussion</li>\n<li>Diminished breath sounds</li>\n<li>Signs of shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest X-ray</li>\n<li>Aspiration (pleural tap)</li>\n<li>Chest CT scan</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Intercostal chest tube (ICT) placement in the mid-axillary line in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space.</li>\n<li>Antibiotics and bronchodilators</li>\n<li>Thoracotomy if persistent or large blood loss\n\t\t\t\t<ul>\n<li><strong>Criteria for Thoracotomy:</strong>\n<ul>\n<li>&gt;1.5 L blood lost in last 1 hour (or)</li>\n<li>&gt;200cc/hour over next 2-4 hours</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Infection and empyema</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QjtdIEiauDG4ofyooJ0s1748762243.mp3", "video": ""}, {"text": "Which of the following is least likely to be found in the posterior mediastinum?", "options": [{"label": "A", "text": "Neurofibroma", "correct": false}, {"label": "B", "text": "Thymoma", "correct": true}, {"label": "C", "text": "Ganglioneuroma", "correct": false}, {"label": "D", "text": "Aneurysm of descending aorta", "correct": false}], "correct_answer": "B. Thymoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/k0bpFa6ULJgwTmU2bhJX1739159064.png", "https://image.prepladder.com/content/8yLqzDORsRrb9vlzT8zO1739159185.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors of mediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior mediastinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle mediastinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior mediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thymomas</li>\n<li>Thymic carcinomas</li>\n<li>Thymic cyst</li>\n<li>Germ cell tumors</li>\n<li>Lymphomas</li>\n<li>Parathyroid adenomas</li>\n<li>Carcinoid tumour</li>\n<li>Fibroma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lymphomas</li>\n<li>Tumors of the heart and great vessels</li>\n<li>Tumours of the trachea, mainstem bronchi, and oesophagus</li>\n<li>Aortic pathologies such as aortic aneurysm, abscess, or dissection.</li>\n<li>Pericardial cysts</li>\n<li>Bronchogenic cysts</li>\n<li>Neuroenteric cyst</li>\n<li>Mesothelial cyst</li>\n<li>Pheochromocytoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurilemomas (schwannomas)</li>\n<li>Neurofibromas</li>\n<li>Ganglioneuromas</li>\n<li>Ganglioneuroblastomas</li>\n<li>Neuroblastomas</li>\n<li>Pheochromocytomas</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yilgQ93EIwkFSV1jgXLf1748760997.mp3", "video": ""}, {"text": "A 45 y/o male presents with chest pain and dyspnea one week after undergoing oesophagal surgery. A pleural tap reveals milky white fluid with high triglyceride levels. Which of the following is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Oral antibiotics", "correct": false}, {"label": "B", "text": "Thoracic duct ligation via thoracoscopy", "correct": false}, {"label": "C", "text": "Oral diet with medium-chain triglycerides", "correct": true}, {"label": "D", "text": "Immediate pleurodesis with talc", "correct": false}], "correct_answer": "C. Oral diet with medium-chain triglycerides", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RP5gKmi6uxGt2r7ieM191748762619.mp3", "video": ""}, {"text": "A 35 y/o male presents with milky urine and abdominal pain after a fatty meal. He reports weight loss and frequent urinary infections. Urinalysis shows chyluria. What is the most likely underlying cause of chyluria in this patient?", "options": [{"label": "A", "text": "Renal stone disease", "correct": false}, {"label": "B", "text": "Filarial infection", "correct": true}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Diabetes mellitus", "correct": false}], "correct_answer": "B. Filarial infection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lBjM57dApWol51NmaKe51748762761.mp3", "video": ""}, {"text": "A 60 y/o male presents with fever, cough, and foul-smelling sputum. A chest X-ray reveals a localized opacity in the apical lower lobe. Sputum culture shows the presence of anaerobic bacteria. Which of the following is the most likely cause?", "options": [{"label": "A", "text": "Aspiration of oropharyngeal secretions", "correct": true}, {"label": "B", "text": "Hematogenous spread from endocarditis", "correct": false}, {"label": "C", "text": "Direct extension from pneumonia", "correct": false}, {"label": "D", "text": "Bronchial obstruction due to lung cancer", "correct": false}], "correct_answer": "A. Aspiration of oropharyngeal secretions", "question_images": ["https://image.prepladder.com/content/hFFFvXAnGtX8Y5th4c0J1739162337.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vROJWtv3jFpFJHQcXtgc1748762875.mp3", "video": ""}, {"text": "A 58 y/o male with a history of chronic kidney disease presents to the clinic with shortness of breath and chest discomfort. A chest X-ray shows a pleural effusion on the right side. Analysis of the pleural fluid reveals the following: Pleural fluid protein to serum protein ratio: 0.7 Pleural fluid lactate dehydrogenase (LDH) to serum LDH ratio: 0.65 Pleural fluid LDH level: 300 U/L (serum LDH upper limit of normal is 200 U/L) Based on these findings and Light’s criteria, which of the following is the most likely cause of this patient's pleural effusion?", "options": [{"label": "A", "text": "Congestive heart failure", "correct": false}, {"label": "B", "text": "Lung cancer", "correct": true}, {"label": "C", "text": "Nephrotic syndrome", "correct": false}, {"label": "D", "text": "Cirrhosis", "correct": false}], "correct_answer": "B. Lung cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Light's criteria for <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> effusions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleural fluid protein to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> protein ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 0.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleural fluid <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 0.6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleural fluid <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2/3 of the upper limit of normal for <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> LDH</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of Pleural Effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exudative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congestive heart failure</li>\n<li>Cirrhosis</li>\n<li>Nephrotic syndrome</li>\n<li>Superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> obstruction</li>\n<li>Pulmonary embolism</li>\n<li>Sarcoidosis</li>\n<li>Hypoalbuminemia</li>\n<li>Fluid retention/overload</li>\n<li>Lobar collapse</li>\n<li>Meigs syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Malignant:</strong>\n<ul>\n<li>Lung cancer</li>\n<li>Lymphoma</li>\n<li>Mesothelioma</li>\n<li>Metastatic cancers</li>\n</ul>\n</li>\n<li><strong>Infectious:</strong>\n<ul>\n<li>Bacterial pneumonia/empyema</li>\n<li>Tuberculosis</li>\n<li>Fungal infections</li>\n<li>Viral infections</li>\n<li>Parasitic infections</li>\n</ul>\n</li>\n<li><strong>Collagen <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Disease-related:</strong>\n<ul>\n<li>Rheumatoid arthritis</li>\n<li>Wegener granulomatosis</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</li>\n<li>Churg-Strauss syndrome</li>\n</ul>\n</li>\n<li><strong>Abdominal/Gastrointestinal disease-related:</strong>\n<ul>\n<li>Esophageal perforation</li>\n<li>Subphrenic abscess</li>\n<li>Pancreatitis/pancreatic pseudocyst</li>\n<li>Meigs syndrome</li>\n</ul>\n</li>\n<li><strong>Other Causes:</strong>\n<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> with infarction</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> grafting</li>\n<li>Radiation/trauma</li>\n<li>Dressler syndrome</li>\n<li>Asbestosis</li>\n<li>After lung transplantation</li>\n<li>After <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplantation</li>\n<li>Drug-induced</li>\n<li>Uremia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tmqDxSUnV0iydyk3kbPR1748763057.mp3", "video": ""}, {"text": "A 72 y/o male with h/o COPD presents with progressive shortness of breath and chest pain. The chest X-ray findings are shown below. Thoracentesis is performed, and analysis of the pleural fluid reveals high protein &amp;amp; LDH levels. Which of the following is the next best step in managing this patient?", "options": [{"label": "A", "text": "Initiate diuretic therapy", "correct": false}, {"label": "B", "text": "Perform a pleural biopsy", "correct": false}, {"label": "C", "text": "Insert a chest tube for drainage", "correct": true}, {"label": "D", "text": "Administer antibiotics", "correct": false}], "correct_answer": "C. Insert a chest tube for drainage", "question_images": ["https://image.prepladder.com/content/EkBHloSJicwEiVPynLX71739162549.png"], "explanation_images": ["https://image.prepladder.com/content/F4Fh1jYivxYwKMmiHJgJ1739162643.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DxbPc0grpXfqwqZ5231f1748763259.mp3", "video": ""}, {"text": "A 50 y/o male patient has been hospitalized following a hip replacement surgery for the past 6 days. He has a history of obesity and smoking. On the sixth day, he suddenly develops shortness of breath, and chest pain, and coughs up blood. Which of the following is the most likely contributing factor to his current condition?", "options": [{"label": "A", "text": "Prolonged immobility", "correct": true}, {"label": "B", "text": "Dehydration", "correct": false}, {"label": "C", "text": "High blood pressure", "correct": false}, {"label": "D", "text": "Recent blood transfusion", "correct": false}], "correct_answer": "A. Prolonged immobility", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s6ln1qsCN9KUseDEPXuH1739167500.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hxOjKs8k932JPyjExZZK1748763591.mp3", "video": ""}, {"text": "Which of the following is the most commonly used gold standard investigation for diagnosing pulmonary embolism in a clinical setting?", "options": [{"label": "A", "text": "Doppler Ultrasound", "correct": false}, {"label": "B", "text": "Chest X-ray", "correct": false}, {"label": "C", "text": "Ventilation-Perfusion (V/Q) Lung Scan", "correct": false}, {"label": "D", "text": "CT Pulmonary Angiography (CTPA)", "correct": true}], "correct_answer": "D. CT Pulmonary Angiography (CTPA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/efGmn6LFWFCNgXIU3tpR1739167655.png", "https://image.prepladder.com/content/Y6GYvOXMU2CxMSDa7BGs1739167811.png", "https://image.prepladder.com/content/BuufsMgN8gOrrpOwlRva1739168011.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms and signs of DVT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PE more likely than an <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart rate &gt;100 bpm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recent <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> or surgery (&lt;4 weeks)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Previous PE or DVT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemoptysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Active Cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score: &gt;4 - PE likely ; &lt;/= 4 - PE unlikely</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ SRB’s Manual of Surgery, 6th Edition, Pg.1108</li><li>↳ Bailey and Love’s Short Practice of Surgery, 28th Edition, Pg.1045</li><li>↳ Pulmonary embolism - PMC</li><li>↳ Pulmonary embolism, part I: Epidemiology, risk factors, and risk stratification, pathophysiology, clinical presentation, diagnosis, and non-thrombotic pulmonary embolism</li><li>↳ Westermark sign | Radiology Reference Article | Radiopaedia.org</li><li>↳ Hampton’s hump, Westermark’s sign and Palla’s sign in acute pulmonary thromboembolism: a rare concurrence | BMJ Case Reports</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SZHL1DJDQ9gFRpqtdrQD1748763725.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 45 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?", "options": [{"label": "A", "text": "Unfractionated heparin followed by warfarin", "correct": false}, {"label": "B", "text": "LMWH followed by oral anticoagulant", "correct": true}, {"label": "C", "text": "Catheter-directed thrombolysis", "correct": false}, {"label": "D", "text": "IVC filter placement", "correct": false}], "correct_answer": "B. LMWH followed by oral anticoagulant", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> with Duplex scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; detects <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> by impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and inability to <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> veins.</p>\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> material completely <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of vein</li>\n<li>Absence of compressibility</li>\n<li>Absence of blood flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venogram </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accurate for detecting and locating <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and differentiating <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> and non-occlusive <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> but less commonly used due to invasiveness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impedance Plethysmography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures changes in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> volume and flow using a cuff. Less useful for calf <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> and previous thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrin and <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Assays</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> products, including D-dimer.</p>\n<p>D-dimer has a high negative predictive value.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radioactive <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"7cd1a840a2169277719756692d362d\">radiolabeled</span> <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> to detect thrombus. Less commonly used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRVI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; Useful for <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> veins and IVC.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcutaneous LMWH: Rapidly anticoagulate confirmed <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> cases.</li>\n<li>Intravenous Unfractionated Heparin: For patients with significant <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>Fondaparinux or Bivalirudin: Alternatives for those with <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> sensitivity or heparin-induced thrombocytopenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transition to Oral Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duration: At least 3 months or longer based on risk factors or recurrence.</li>\n<li>Novel anticoagulants (NOACs): Rivaroxaban, <span class=\"customMeta\" data-dictid=\"bd0e99d93a169277718152523f2534\">Apixaban</span> (factor Xa inhibitors), Dabigatran (direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitor).</li>\n<li>Vitamin K Antagonists: <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">Warfarin</span> (alternative to NOACs).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heparin: <span class=\"customMeta\" data-dictid=\"0f61fd74c41692777180190320f12e\">Activated partial <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">thromboplastin</span> time</span> (APTT).</li>\n<li>Warfarin: INR maintained between 2.0 to 3.0.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Patients with contraindications to Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporary <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> Filter:</strong> Consider if <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk prevents <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> or to prevent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism. It does not treat the existing <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and is associated with long-term complications. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endovascular Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombus removal, lysis, and stenting.</li>\n<li>Beneficial in selected patients, especially those with <span class=\"customMeta\" data-dictid=\"dae3263b2716927771896cfc9f45c8\">iliofemoral</span> thrombosis, to reduce risk of chronic post-thrombotic syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eqMGtMY0Dat5jpYlISe31746795675.mp3", "video": ""}, {"text": "An infant presents with a large, rapidly growing vascular malformation, along with severe thrombocytopenia and microangiopathic hemolytic anemia. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Klippel-Trénaunay Syndrome", "correct": false}, {"label": "B", "text": "Kasabach-Merritt Syndrome", "correct": true}, {"label": "C", "text": "Sturge-Weber Syndrome", "correct": false}, {"label": "D", "text": "Capillary Hemangioma", "correct": false}], "correct_answer": "B. Kasabach-Merritt Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Kyol7NY7jK0qx8NZqrQJ1740075814.png", "https://image.prepladder.com/content/mTbcefTUw81YKoF4wqGv1740075883.png", "https://image.prepladder.com/content/i0pF2M07TzkYUCsKwsen1740075957.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Klippel-Trénaunay syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kasabach-Merritt Syndrome (KMS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A mesodermal <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> characterized by:\n\t\t\t\t<ul>\n<li>Cutaneous nevus,</li>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"e37f672aa61692777201594a096de3\">vestigial</span> veins with <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins,</li>\n<li>Soft-tissue and bone hypertrophy. <strong>(Option A)</strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Segments of deep veins are hypoplastic or aplastic.</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of lymphatics.</li>\n<li><strong>Treatment:</strong>\n<ul>\n<li>Conservative management with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> stockings.</li>\n<li>Removal of large <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins done only if deep veins are patent.</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Hyung Min Sung , Ho Yun Chung , Seok Jong Lee , Jong Min Lee , Seung Huh , Jeong Woo Lee , Kang Young Choi , Jung Dug Yang , Byung Chae Cho\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.thieme-connect.de/products/ejournals/html/10.5999/aps.2015.42.5.552\" data-tags=\"\" height=\"515\" src=\"https://image.prepladder.com/content/Kyol7NY7jK0qx8NZqrQJ1740075814.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A life-threatening <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> of <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> characterized by:\n\t\t\t\t<ul>\n<li>Thrombocytopenia</li>\n<li>Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</li>\n<li>Consumptive coagulopathy. <strong>(Option B)</strong></li>\n</ul>\n</li>\n<li>Rapidly growing <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> tumor</li>\n<li><strong>Treatment: </strong>\n<ul>\n<li>Mainly supportive care</li>\n<li>Embolization: Possible if a single <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessel is present.</li>\n<li>Medical Therapies: Steroids,vincristine and sirolimus.</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Anne Beissel, Stéphanie Riou, Céline Julie Fischer Fumeaux, Marie Cassart, Sébastien Blanc, Olivier Claris, Laurent Guibaud\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.580\" data-tags=\"\" height=\"301\" src=\"https://image.prepladder.com/content/mTbcefTUw81YKoF4wqGv1740075883.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UJFWXxum1vTIn2L4ma7P1747158051.mp3", "video": ""}, {"text": "A 50-year-old man presents with prominent varicose veins on his medial thigh and calf. Upon examination, incompetence of the great saphenous vein (GSV) is identified. The surgeon is considering the appropriate surgical intervention. What is the primary indication for performing Saphenofemoral Junction Ligation and GSV Stripping?", "options": [{"label": "A", "text": "Varicose veins on the posterolateral calf due to small saphenous vein incompetence", "correct": false}, {"label": "B", "text": "Incompetence of the great saphenous vein with varicose veins on the medial thigh and calf", "correct": true}, {"label": "C", "text": "Varicose veins on the anterior thigh due to incompetent perforator veins", "correct": false}, {"label": "D", "text": "Small varicose veins unsuitable for endovenous ablation", "correct": false}], "correct_answer": "B. Incompetence of the great saphenous vein with varicose veins on the medial thigh and calf", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s5qCHfd0ZuX26KOpz5071740074165.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Open Surgery Procedure</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Saphenofemoral <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">Junction</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">Ligation</span> and Great Saphenous <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> Stripping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indication:</strong> Used for <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins in the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh and calf due to great saphenous <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (GSV) incompetence. <strong>(Option B)</strong><strong> (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Procedure:</strong> An <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> is made in the <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> to access the saphenofemoral <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> where the GSV meets the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vein. Tributaries of the GSV are ligated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Stripping:</strong> The GSV is tied off at the junction, and a device is inserted into the GSV and pulled out through an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> near the knee, <span class=\"customMeta\" data-dictid=\"85cb03377b1692777199d46846ce58\">stripping</span> the <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> as it is removed.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Saphenopopliteal <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">Junction</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">Ligation</span> and Small Saphenous <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> Stripping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indication:</strong> Used for <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins on the <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> calf due to small saphenous <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (SSV) incompetence. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Procedure:</strong> An <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> is made to access and <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">ligate</span> the saphenopopliteal <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> where the SSV joins the popliteal vein.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Stripping:</strong> Similar to the GSV procedure, the surgeon either strips the <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> using a device or resects the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> portion of the vein.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nPQRafhEpiAayI29MMas1747159106.mp3", "video": ""}, {"text": "A 55-year-old male with chronic venous insufficiency presents with a venous ulcer on his lower leg. He has a history of prolonged standing at work and reports aching and heaviness in his legs. What is correct regarding compression therapy in this patient?", "options": [{"label": "A", "text": "Class 1 compression hosiery exerts 18-24 mmHg of pressure", "correct": false}, {"label": "B", "text": "Compression bandaging typically exerts less pressure than compression hosiery", "correct": false}, {"label": "C", "text": "Compression bandaging should be avoided in patients with a history of venous ulcers", "correct": false}, {"label": "D", "text": "Compression therapy is most effective when it exerts a graduated pressure to promote venous return", "correct": true}], "correct_answer": "D. Compression therapy is most effective when it exerts a graduated pressure to promote venous return", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:221px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pressure (mmHg)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Class 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>14–17 <strong>(Vs Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Class 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>18–24</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Class 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>25–35</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ABPI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure (mmHg)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Venous Ulcers (no arterial disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not Applicable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>35–40</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed Ulcers (with arterial disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5–0.8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe Arterial Compromise</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.5 or ankle pressure &lt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Revascularization is needed before compression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QUnzs2yfpASaoIXbcOQA1747159817.mp3", "video": ""}, {"text": "Which of the following statements about the pathophysiology of varicose veins is incorrect?", "options": [{"label": "A", "text": "Defects in the walls or valves of the veins lead to retrograde blood flow.", "correct": false}, {"label": "B", "text": "Inflammatory changes in walls lead to dilatation, elongation and valvular dysfunction.", "correct": false}, {"label": "C", "text": "The veins have a low end-diastolic volume.", "correct": true}, {"label": "D", "text": "Chronic ambulatory venous hypertension develops.", "correct": false}], "correct_answer": "C. The veins have a low end-diastolic volume.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pzODGnahLRrvMNB02VMb1740071767.png", "https://image.prepladder.com/content/pAJs0aA0h2JI4gYqYwIf1740071798.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YBzAZV5PrkbKUjc6mNFZ1747156456.mp3", "video": ""}, {"text": "A patient comes to the surgery OPD complaining of small swellings and a wound on his right lower leg. On clinical evaluation, he is found to have hyperpigmentation in his right leg around the ankle and lower third of the leg. He also has a healed venous ulcer and is symptomatic. According to the CEAP classification, what is the clinical stage of the disease in this case?", "options": [{"label": "A", "text": "C5a", "correct": false}, {"label": "B", "text": "C5s", "correct": true}, {"label": "C", "text": "C3r", "correct": false}, {"label": "D", "text": "C6", "correct": false}], "correct_answer": "B. C5s", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/P9Us4mLcrVn3s5aFOrDE1740072324.png", "https://image.prepladder.com/content/KtmsLg5xNBYzACxwSOFU1740072391.png", "https://image.prepladder.com/content/tBHJpMk8pDy4nTcBRkah1740073587.png", "https://image.prepladder.com/content/Bjz6NPNBOhXp57elSFo71740073661.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:488px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For<strong> clinical</strong> classification:</p>\n<ul>\n<li>No signs of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease</li>\n<li>Telangiectasia (&lt;1 mm) or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins ( 1-3 mm dilated veins)</li>\n<li>Varicose veins (&gt;3 mm )</li>\n<li><strong>Edema </strong></li>\n<li>Pigmentation or eczema</li>\n<li>LDS or atrophic blanche</li>\n<li>Corona phlebectatica</li>\n<li><strong>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></li>\n<li><strong>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Clinical class can be further characterised as <strong>symptomatic </strong>(s), <strong>asymptomatic </strong>(a) or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> following previous successful treatment or <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> (r), e.g. C2a, C2s, C6r.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>C0</p>\n<p>C1</p>\n\t\t\t \n\n\t\t\t<p>C2</p>\n<p><strong>C3</strong></p>\n<p>C4a</p>\n<p>C4b</p>\n<p>C4c</p>\n<p><strong>C5</strong></p>\n<p><strong>C6</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <strong>etiological</strong> classification:</p>\n<ul>\n<li>Congenital</li>\n<li>Primary</li>\n<li>Secondary (post-thrombotic)</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> cause identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Ec</p>\n<p>Ep</p>\n<p>Es</p>\n<p>En</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <strong>anatomical</strong> classification:</p>\n<ul>\n<li>Superficial veins</li>\n<li>Perforator veins</li>\n<li>Deep veins</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> location identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>As</p>\n<p>Ap</p>\n<p>Ad</p>\n<p>An</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <strong>pathophysiological </strong>classification:</p>\n<ul>\n<li>Reflux</li>\n<li>Obstruction</li>\n<li>Reflux and obstruction</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"19bbbcd51e16927771947c31adcdd0\">pathophysiology</span> identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Pr</p>\n<p>Po</p>\n<p>Pr,o</p>\n<p>Pn</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bNzl9WnydI74ptTXiSzo1747156881.mp3", "video": ""}, {"text": "A 50-year-old woman with inflammatory bowel disease presents with a painful ulcer on her leg. The ulcer has a necrotic edge and a purulent base, with significant surrounding erythema. What type of ulcer is most consistent with this presentation?", "options": [{"label": "A", "text": "Neurotrophic ulcer", "correct": false}, {"label": "B", "text": "Pyoderma gangrenosum", "correct": true}, {"label": "C", "text": "Venous ulcer", "correct": false}, {"label": "D", "text": "Arterial ulcer", "correct": false}], "correct_answer": "B. Pyoderma gangrenosum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iBlIsM7P5PKPgtq5w6Gf1740076259.png", "https://image.prepladder.com/content/SmFQW5pvClYtNKj3MptX1740076314.png", "https://image.prepladder.com/content/On88Wycn3XiHmIHnSmHR1740076367.png", "https://image.prepladder.com/content/CguPIQX4I5aLCRKfOn8D1740076454.png", "https://image.prepladder.com/content/em4Fs7lLZjCH14roJcJy1740076508.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:799px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lesion Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ischemic/ arterial </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking,</p>\n<p>Intermittent claudications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal, on <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of foot or toes, <strong>over bony prominences</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe, particularly at night; relieved by dependency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular edge; poor <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, dry necrotic base; round or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> with sharp demarcation;</p>\n<p>no surrounding inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trophic changes of chronic ischemia, pale, hair loss, atrophic skin, cool feet; absence of pulses, prolonged <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> refill; ankle <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> index (ABI) &lt;0.5; dependent rubor, <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> pallor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varicose veins, DVT, trauma, surgery, multiple pregnancies; aching/ <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> worse at end of day, relieved with elevation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower third of leg (<strong>gaiter area</strong>); between <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> and lower calf, majority at <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> malleolus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild; relieved by elevation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shallow, irregular/shaggy shape; granulating base; flat or steep <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> margins; fibrinous material at <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> bed with moderate to heavy exudate; surrounding <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipodermatofibrosis/ lipodermatosclerosis, pigmentation, edema, <span class=\"customMeta\" data-dictid=\"b04fb2c703169277718295309e32d6\">atrophie</span> blanche; telangiectasia; normal <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> refill time, normal ankle <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> index (ABI)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurotrophic </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numbness, paresthesias, burning, loss sensation in foot, Diabetes mellitus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Under calluses or pressure points (e.g., <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> aspect of first or fifth <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> joint)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Punched-out, with deep sinus, variable depth partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> to severe involving tendon, fascia, joint capsule, or bone; surrounding <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Demonstrable neuropathy, may be associated with underlying osteomyelitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vasculitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of primary or secondary <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pretibial and <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of foot but not always geographically limited</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extremely painful</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple, punched-out, inflamed <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> base (pathergy phenomenon); surrounding <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> present; surrounding skin shows reticulate <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> pattern</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fat necrosis/chronic <span class=\"customMeta\" data-dictid=\"15ca8931e616927771943d31a798a7\">panniculitis</span> on pathology</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertensive (local infarct)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal pulses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral malleoli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black necrosis; surrounding <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aka Martorell's ulcer; seen in patients with prolonged/ suboptimal controlled hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyoderma</strong></p>\n<p><strong>Gangrenosum</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unknown pathogenesis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Develops in sites of previous trauma, around scars, donor sites used for grafting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-infective <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> base</strong>; well-defined, bluish, undermined borders; surrounding erythema; deep necrotic ulcer; surrounding <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen with <strong>inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</strong>, immunodeficient states, myeloma, leukemia, Behcet's syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LBGb3MPdAbkOIfSpjfLh1747157439.mp3", "video": ""}, {"text": "A 62-year-old man has a chronic ulcer on his leg from a burn injury sustained 12 years ago. Recently, the ulcer has developed indurated, painless, raised edges and surrounding fibrosis. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Venous ulcer", "correct": false}, {"label": "B", "text": "Pressure ulcer", "correct": false}, {"label": "C", "text": "Marjolin’s ulcer", "correct": true}, {"label": "D", "text": "Actinic keratosis", "correct": false}], "correct_answer": "C. Marjolin’s ulcer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qp2Uhm4wtfdUOIHeWjsV1740076129.png", "https://image.prepladder.com/content/k9Cq90UU8p3cKzCNyzby1740076055.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:573px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Responsible for 85% of all chronic limb ulcers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Venous disease (superficial or deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"9a02ac20c3169277719094af57128d\">incompetence</span> or obstruction)</li>\n<li>Arterial ischemic ulcer</li>\n<li>Vasculitic ulcer</li>\n<li>Traumatic ulcer</li>\n<li>Neuropathic ulcer</li>\n<li>Neoplastic ulcer</li>\n<li>Infections.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Old theories: <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">Fibrin</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> theory and white cell trapping theory but these have not been confirmed.</li>\n<li>Presently: <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">Ambulatory</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> is the primary cause.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gaiter's Zone:</strong> Common <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> location around and above the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"57986121e1169277719156c8d3120e\">malleoli</span> due to numerous perforators.</li>\n<li><strong>Ulcer:</strong> Large with gently sloping edge and <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, nonhealing, tender, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> with secondary infections.</li>\n<li>Surrounding skin often shows<strong> thickening, inflammation, induration, <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> (hemosiderosis) and fibrosis</strong>. <strong>(Option A)</strong></li>\n<li><strong>Lipodermatosis:</strong> Chronic inflammation, <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and thickening of the skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue of the lower leg with <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> and a tight, contracted appearance, often with <span class=\"customMeta\" data-dictid=\"a6866cebd81692777180cccaabbb81\">Achilles tendon</span> contracture. Suggests severe chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease and gives a <strong>champagne bottle</strong> appearance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Duplex scan</strong>: To assess deep and <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins.</li>\n<li><strong>Biopsy:</strong> For <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> ulcers or suspected <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (e.g., Marjolin's ulcer).</li>\n<li>Additional tests: Full blood count, blood glucose, ESR/CRP, sickle cell test, <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> screening if <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> appears atypical.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Compression Therapy</strong></li>\n<li><strong>Superficial <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> or surgery</strong></li>\n<li><strong>Bisgaard Method:</strong> Measures to reduce edema, increase <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> and promote <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> healing\n\t\t\t\t<ul>\n<li>Elevation</li>\n<li>Massage of <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> area</li>\n<li>Passive and active exercise</li>\n</ul>\n</li>\n<li>Other Treatments: Pentoxifylline, horse <span class=\"customMeta\" data-dictid=\"008c649fc21692777184c87752a892\">chestnut</span> extract, biological dressings, grafts and antibiotics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemorrhage</li>\n<li>Periostitis over tibia</li>\n<li>Marjolin's Ulcer:\n\t\t\t\t<ul>\n<li>Well-differentiated <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> (squamous cell or <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cell carcinoma) occurring in chronic scars (e.g., burn scars, <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcers).</li>\n<li>Indurated, painless, non-tender <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with raised, everted edges and surrounding fibrosis. <strong>(Option C)</strong></li>\n<li>Treatment: Wide local excision</li>\n</ul>\n</li>\n<li>Infection</li>\n<li>Talipes equinovarus</li>\n<li>Disability</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 64-year-old woman is scheduled for the great saphenous vein (GSV) stripping to treat her varicose veins. What is the most likely nerve injury she might experience post-operatively?", "options": [{"label": "A", "text": "Sural nerve", "correct": false}, {"label": "B", "text": "Common peroneal nerve", "correct": false}, {"label": "C", "text": "Saphenous nerve", "correct": true}, {"label": "D", "text": "Tibial nerve", "correct": false}], "correct_answer": "C. Saphenous nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jd175XEPbCyKd9MHxyQo1747158282.mp3", "video": ""}, {"text": "A patient with chronic venous insufficiency presents with symptomatic varicose veins. The physician decides to use foam sclerotherapy, specifically the Tessari technique, to treat the affected veins. What is the typical ratio of sclerosant to air used in the Tessari technique for creating the foam?", "options": [{"label": "A", "text": "1:1", "correct": false}, {"label": "B", "text": "1:2", "correct": false}, {"label": "C", "text": "1:3", "correct": true}, {"label": "D", "text": "1:6", "correct": false}], "correct_answer": "C. 1:3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RFMDrEoW6kshVkKVtzmM1739122632.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sclerotherapy</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> agent, typically <strong>sodium tetradecyl sulphate</strong>, is <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> into the affected vein.</li>\n<li>This agent <strong>damages the <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> lining, causing it to collapse</strong> and eventually be absorbed by the body.</li>\n<li>To enhance the effectiveness of the sclerosant, it is <strong>mixed with air to create a foam</strong>.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> allows for greater contact with the <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> wall and displaces blood that could <span class=\"customMeta\" data-dictid=\"8bc8a6d0441692777190e9bed75e91\">inactivate</span> the sclerosant</li>\n</ul>\n<p><strong>Indications:</strong> Telangiectasias, <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins, and small, nonaxial <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins (&lt;6 mm) visible in chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease; suitable for patients with persistent symptoms despite medical management.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tessari Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sclerosants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications and Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Foam Preparation</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Two syringes: one with sclerosant, one with air/gas (CO2)</li>\n<li>Connected via multi-way stopcock.</li>\n<li><strong>Sclerosant to air ratio is usually 1:3 or 1:4</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Repeated plunger action to create foam</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>STS:</strong> <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">Synthetic</span> sodium salt with <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> properties</li>\n<li><strong>Polidocanol:</strong> <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">Synthetic</span> <span class=\"customMeta\" data-dictid=\"6f2c4e308c16927771964ef7064e47\">polyethylene</span> glycol, also an anesthetic.</li>\n<li>Effective for telangiectasias, <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins</li>\n<li><strong>HTS:</strong> 23% <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">hypertonic</span> saline, osmotic agent</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Candidates:</strong> <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">Asymptomatic</span> patients and those with controlled recent or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> may undergo <span class=\"customMeta\" data-dictid=\"c6eed7f30016927771988ace779458\">sclerotherapy</span> without additional diagnostics.</li>\n<li><strong>Contraindications:</strong> Avoid <span class=\"customMeta\" data-dictid=\"c6eed7f30016927771988ace779458\">sclerotherapy</span> during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> or pregnancy.</li>\n<li><strong>Risks</strong>: Microembolism risk</li>\n<li><strong>Vessel Size:</strong> Suitable for veins up to 6 mm in diameter, including small, nonaxial <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins, <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins, and telangiectasias.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Injection Technique</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Downstream <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> from larger to smaller veins.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Controlled <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> volume to displace blood.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Advantages</strong></p>\n</td>\n<td colspan=\"3\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Minimally invasive, enhanced efficacy, safety profile.</li>\n<li>Reduced volume requirement due to foam.</li>\n<li>STS: Rapid <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> in blood, effective for larger veins.</li>\n<li>Polidocanol: Decreased risk of thrombosis, suitable for smaller veins.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yGkK9sMvezFEAHjScuuA1747158577.mp3", "video": ""}, {"text": "Which of the following statements best describes the difference between Dodd and Cockett surgeries?", "options": [{"label": "A", "text": "Dodd: ligation in the thigh; Cockett: ligation in the lower leg", "correct": true}, {"label": "B", "text": "Dodd: open surgery; Cockett: endoscopic", "correct": false}, {"label": "C", "text": "Dodd: targets superficial veins; Cockett: targets deep veins", "correct": false}, {"label": "D", "text": "Dodd: higher risk of nerve injury; Cockett: lower risk", "correct": false}], "correct_answer": "A. Dodd: ligation in the thigh; Cockett: ligation in the lower leg", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oZNziPqIYRf81a4WLkLu1740074849.png", "https://image.prepladder.com/content/dli6yD1WeSDz3mECKLZ61740075049.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Current Relevance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>SEPS (Subfascial <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">Perforator</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> Surgery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Treats chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> by <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Minimally invasive; uses an endoscope</strong> to access and clip/divide <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Less pain, shorter recovery, fewer complications.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Preferred over open surgery; effective in preventing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dodd Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Addresses <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins in the thigh.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Open surgery</strong>; <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> made to <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">ligate</span> or divide thigh <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins (Dodd perforators).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Direct access to <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Less common due to SEPS; historically significant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cockett Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Targets <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins in the lower leg.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Open surgery</strong>; <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the lower leg to <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">ligate</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins near the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> (Cockett perforators).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Direct access to lower leg <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Less common due to SEPS; historically significant.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TOULwIk6OqnMCve3zCi71747158752.mp3", "video": ""}, {"text": "A 45-year-old woman presents with symptomatic varicose veins. She is interested in learning about the available treatment options and their benefits. Her primary concern is to minimize recovery time and reduce post-operative pain. Which of the following surgical approaches is most appropriate for this patient?", "options": [{"label": "A", "text": "Saphenofemoral ligation and great saphenous stripping", "correct": false}, {"label": "B", "text": "Saphenopopliteal junction ligation and small saphenous stripping", "correct": false}, {"label": "C", "text": "Endovenous laser ablation (EVLA)", "correct": true}, {"label": "D", "text": "Phlebectomy as a standalone procedure", "correct": false}], "correct_answer": "C. Endovenous laser ablation (EVLA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mgEd8ONRfu13KT8bcXnM1740074073.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endovenous Laser <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (EVLA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Minimally invasive, uses laser energy to close <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> veins.</li>\n<li>Gold standard and has largely replaced <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> and stripping.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Minimally invasive, uses <span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\">radiofrequency</span> energy to close veins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treats <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"41621596221692777200ad9bb50bc5\">truncal</span> veins, often used for <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treats <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"41621596221692777200ad9bb50bc5\">truncal</span> veins, similar to EVLA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> (&gt;95% <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> rate)</li>\n<li>Cost-effective</li>\n<li>Versatile (treats large and small veins)</li>\n<li>Effective for <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> veins</li>\n<li>Standard fibers treat <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> veins</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> (&gt;95% <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> rate)</li>\n<li>Standardized treatment cycles</li>\n<li>Potentially <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> post-procedural pain and bruising</li>\n<li>Simplified procedural <span class=\"customMeta\" data-dictid=\"3a6d14db861692777198565f57828c\">setup</span> without laser safety protocols</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Applications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Varicose veins</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> treatment, when combined with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> therapy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Varicose veins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Differences</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laser energy used for <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> ablation</li>\n<li>Requires laser safety protocols</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radiofrequency energy used for <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> ablation</li>\n<li>Automated energy delivery simplifies the procedure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pvnnO1OpCv2Jp1Bo8SQn1747159507.mp3", "video": ""}, {"text": "A 45-year-old male presents with chronic leg pain, swelling, and visible varicose veins. A duplex ultrasound is performed to assess venous function. Which of the following statements is TRUE regarding interpreting the duplex scan in this patient?", "options": [{"label": "A", "text": "The duplex scan should be performed with the patient in a supine position", "correct": false}, {"label": "B", "text": "A reflux time of less than 500 milliseconds is clinically significant", "correct": false}, {"label": "C", "text": "Presence of perforator vein with a diameter &amp;gt;3.5 mm is significant", "correct": true}, {"label": "D", "text": "The duplex scan is primarily used to locate perforating veins", "correct": false}], "correct_answer": "C. Presence of perforator vein with a diameter &gt;3.5 mm is significant", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Position during Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Standing or trunk-elevated (NOT supine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reflux Time (≥ 500 ms)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicative of significant reflux</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perforator <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">Diameter</span> (&gt; 3.5 mm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suggestive of significant <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">perforator</span> reflux</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Use of Duplex Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> reflux, NOT locating perforators</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4DG6bMj5jfcd8sUxvlxs1747160098.mp3", "video": ""}, {"text": "The following test was conducted in the clinic for a patient suffering from varicose veins. On releasing only tourniquet 3, the filling of blood was observed. What does this signify?", "options": [{"label": "A", "text": "Hunterian’s perforator incompetence", "correct": false}, {"label": "B", "text": "Boyd’s perforator incompetence", "correct": false}, {"label": "C", "text": "Dodd’s perforator incompetence", "correct": false}, {"label": "D", "text": "Cockett’s perforator incompetence", "correct": true}], "correct_answer": "D. Cockett’s perforator incompetence", "question_images": ["https://image.prepladder.com/content/KmaPf1q3tOb4zc7Jv8Ub1740073833.png"], "explanation_images": ["https://image.prepladder.com/content/drDfdNd0GUF4p79LlHAa1740073988.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5FH9G6gcKi4EyrLLhvDJ1747157173.mp3", "video": ""}, {"text": "A patient with varicose veins is being examined in the surgical OPD. The Brodie-Trendelenburg I test is done for the patient, and the surgeon notices that blood is filling from above. What does this signify?", "options": [{"label": "A", "text": "Valvular incompetence", "correct": false}, {"label": "B", "text": "Perforator incompetence", "correct": false}, {"label": "C", "text": "Sapheno-femoral incompetence", "correct": true}, {"label": "D", "text": "Presence of DVT", "correct": false}], "correct_answer": "C. Sapheno-femoral incompetence", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5j6BRy9wQuwL3DnGOtOa1747157035.mp3", "video": ""}, {"text": "A 45-year-old man presents with left leg swelling and pain for 3 days. Duplex ultrasonography reveals a thrombus in the popliteal vein. Which of the following veins is most likely to be involved next in the progression of this DVT?", "options": [{"label": "A", "text": "Great saphenous vein", "correct": false}, {"label": "B", "text": "Common femoral vein", "correct": true}, {"label": "C", "text": "Posterior tibial vein", "correct": false}, {"label": "D", "text": "External iliac vein", "correct": false}], "correct_answer": "B. Common femoral vein", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8AqNpsNcB3DiFNEmkuHQ1740060599.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ibF03nBqAKkJhCG6DDVA1746795396.mp3", "video": ""}, {"text": "After noticing small swellings over his legs, a 60-year-old man comes to the surgical OPD. He is a tailor by occupation and works long hours. He explains that he experiences a heaviness and aching in the legs after a long day of work but is relieved once he elevates his legs and rests. Which of the following is not a more severe sign of this disease?", "options": [{"label": "A", "text": "Thrombophlebitis", "correct": false}, {"label": "B", "text": "Lipodermatosclerosis", "correct": false}, {"label": "C", "text": "Ulceration", "correct": false}, {"label": "D", "text": "Pedal edema", "correct": true}], "correct_answer": "D. Pedal edema", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DTrt89VhwATNBeTSxjP21740071837.png", "https://image.prepladder.com/content/p6KuGemlv2gcBkT0rFbo1740071884.png", "https://image.prepladder.com/content/u7WAGgJdWlJi0FrfY8zs1740071925.png", "https://image.prepladder.com/content/AonVrjuIg1NR8E5efNgN1740071968.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/87mU5O2t9jvUDC5NWKAP1747156635.mp3", "video": ""}, {"text": "A 50-year-old woman presents with visible, dilated veins on both legs. She has a history of two pregnancies and works as a retail clerk. On examination, the dilated veins are most prominent along the posterior aspect of her calves. Which of the following describes the classification of her varicose veins based on the involved venous system?", "options": [{"label": "A", "text": "Great Saphenous Vein System", "correct": false}, {"label": "B", "text": "Small Saphenous Vein System", "correct": true}, {"label": "C", "text": "Non-saphenous veins", "correct": false}, {"label": "D", "text": "Perforator veins", "correct": false}], "correct_answer": "B. Small Saphenous Vein System", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oe3u8ueq5Mftq8RE5A8G1746796871.mp3", "video": ""}, {"text": "A 55-year-old woman presents with varicose veins in her left leg. On examination, you notice dilated, tortuous veins along the posterior aspect of her calf and lateral thigh. To accurately map the incompetent veins for potential treatment, which of the following describes the most likely location of the Boyd perforator vein?", "options": [{"label": "A", "text": "Medial ankle, posterior to the medial malleolus", "correct": false}, {"label": "B", "text": "Medial calf, approximately 10 cm above the medial malleolus", "correct": false}, {"label": "C", "text": "Lateral calf, at the junction of the middle and lower thirds", "correct": false}, {"label": "D", "text": "Medial knee, approximately 10 cm below the knee joint line", "correct": true}], "correct_answer": "D. Medial knee, approximately 10 cm below the knee joint line", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YLNw7xI4d2KpkeJOF41c1740071626.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0beOTEkIOv6ieMBOCqwE1746796627.mp3", "video": ""}, {"text": "A 55-year-old woman presents with recurrent episodes of tender, erythematous cord-like swellings along different superficial veins of her lower extremities over the past 3 months. Which of the following is most likely to be associated with this presentation?", "options": [{"label": "A", "text": "Recent childbirth", "correct": false}, {"label": "B", "text": "Thromboangiitis obliterans", "correct": false}, {"label": "C", "text": "Pancreatic malignancy", "correct": true}, {"label": "D", "text": "Polycythemia vera", "correct": false}], "correct_answer": "C. Pancreatic malignancy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vg6fiONqfbep7IqjNYv01746796467.mp3", "video": ""}, {"text": "A 20-year-old competitive swimmer presents with a 2-day history of left arm pain, swelling, and mild discoloration after intense training. Duplex ultrasound shows a thrombus in the left subclavian vein. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Thoracic outlet syndrome", "correct": false}, {"label": "B", "text": "Paget-Schrotter syndrome", "correct": true}, {"label": "C", "text": "Raynaud's phenomenon", "correct": false}, {"label": "D", "text": "Lymphedema", "correct": false}], "correct_answer": "B. Paget-Schrotter syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dotUBuiOEB6upfvXSUo81740064659.png", "https://image.prepladder.com/content/xu3xCG4eV9oKt5a1rsDJ1740071296.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Upper <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">Extremity</span> <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less common than lower <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> DVT, comprising ~5% of all <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> cases.</li>\n<li>Serious condition with a risk of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> in up to one-third of cases.</li>\n<li>Typically involves <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of the <strong>axillary </strong>or <strong>subclavian </strong>veins.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Categories</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Idiopathic:</strong></p>\n<ul>\n<li><strong>Idiopathic upper <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> DVT</strong>\n<ul>\n<li>Idiopathic cases warrant evaluation for <span class=\"customMeta\" data-dictid=\"c8d9b6cbbb1692777194c4bc31f01f\">occult</span> malignancy.</li>\n</ul>\n</li>\n<li><strong>Paget-Schroetter syndrome (Option B)</strong>\n<ul>\n<li>Effort <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> due to <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> compression.</li>\n<li>Often seen in young athletes with repetitive upper <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> motion (e.g., swimming).</li>\n<li>Anatomic anomalies like <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> ribs or <span class=\"customMeta\" data-dictid=\"ff4da5559b169277719349b30b2f82\">myofascial</span> bands can cause <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> compression.</li>\n<li>It may develop as a sequale of <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome</li>\n<li>Diagnosis may involve plain films to confirm <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome (as shown in the image below).</li>\n<li>Treatment: Initial <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">thrombolysis</span> followed by <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> (first rib and <span class=\"customMeta\" data-dictid=\"c9b658143016927771985deca1dbb9\">scalene</span> muscle resection).</li>\n<li>Surgical approach: <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">Reconstruction</span> of axillary and <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> veins.</li>\n<li>Post-surgery: <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">Anticoagulation</span> for 6-12 months.</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Ijaopo R, Oguntolu V, DCosta D, Garnham A, Hobbs S,\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:A-case-of-Paget-Schroetter-syndrome-(PSS)-in-a-young-judo-tutor-a-case-report-13256_2016_848_Fig2_HTML.jpg\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/dotUBuiOEB6upfvXSUo81740064659.png\" width=\"500\"/></p>\n<p><strong>Secondary:</strong></p>\n<ul>\n<li>More common</li>\n<li>Due to <span class=\"customMeta\" data-dictid=\"3d7fbfbd7f1692777190bde80be811\">indwelling</span> central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> catheters, pacemakers, <span class=\"customMeta\" data-dictid=\"70158d6a8316927772008b29ca8100\">thrombophilia</span> or <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilateral swelling</li>\n<li>Pain</li>\n<li>Extremity discomfort</li>\n<li>Erythema</li>\n<li>Palpable cord</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duplex ultrasonography</li>\n<li>Venography or magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> venography</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anticoagulation therapy: <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">Heparin</span> or LMWH plus <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">warfarin</span> for at least 3 months is the mainstay of treatment.</li>\n<li>Thrombolysis does not significantly reduce long-term manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrence</li>\n<li>Post-thrombotic syndrome (PTS)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LGVHJN5Rg7Pvn3MmA9vh1746796288.mp3", "video": ""}, {"text": "A 30-year-old woman is in the post-operative ward after a cesarean section. She had no complications and gave birth to a healthy baby. Which of the following is a prophylactic step she needs to be advised to prevent deep vein thrombosis?", "options": [{"label": "A", "text": "Early mobilization along with compression stockings", "correct": true}, {"label": "B", "text": "Low molecular weight heparin", "correct": false}, {"label": "C", "text": "Low-dose unfractionated heparin", "correct": false}, {"label": "D", "text": "Fondaparinux", "correct": false}], "correct_answer": "A. Early mobilization along with compression stockings", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3qct6dGTtJtrxF9FHuKQ1740071085.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:469px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level of risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suggested <span class=\"customMeta\" data-dictid=\"773ad0a8891692777200325e6fb283\">thromboprophylaxis</span> options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very low-risk</p>\n<p>General or abdominopelvic surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No specific thromboprophylaxis</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"3243864c2316927771817341380a07\">ambulation</span> along with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> stockings <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk</p>\n<p>General or abdominopelvic surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mechanical prophylaxis</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"3243864c2316927771817341380a07\">ambulation</span> and mechanical device (compression stockings)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate risk</p>\n<p>General or abdominopelvic surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LMWH (at recommended doses) <strong>(Option B)</strong></li>\n<li>LDUH <strong>(Option C) </strong>or mechanical prophylaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mechanical prophylaxis</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"3243864c2316927771817341380a07\">ambulation</span> and mechanical device( <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> stockings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk</p>\n<p>General or abdominopelvic surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LMWH (at recommended doses),</li>\n<li>fondaparinux <strong>(Option D)</strong>,<strong> </strong>and mechanical prophylaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk</p>\n<p>General or abdominopelvic surgery for cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mechanical thromboprophylaxis</li>\n<li>Extended-duration LMWH (4 weeks)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3j8AP3EKG92Pnllxw2JJ1746796152.mp3", "video": ""}, {"text": "A patient came with complaints of discoloration of his left leg as shown in the image. He has a history of deep vein thrombosis and has been inconsistent on medication. What is the possible diagnosis here?", "options": [{"label": "A", "text": "Venous gangrene", "correct": false}, {"label": "B", "text": "Venous ulcer", "correct": false}, {"label": "C", "text": "Atrophic blanche", "correct": false}, {"label": "D", "text": "Post-thrombotic leg", "correct": true}], "correct_answer": "D. Post-thrombotic leg", "question_images": ["https://image.prepladder.com/content/0zF2F4KQgBAJtlt9VGsP1740061415.png"], "explanation_images": ["https://image.prepladder.com/content/GxbKd80N7PagMc4xDi801740061471.png", "https://image.prepladder.com/content/T2RuEDo0fjphsxoYxTjX1740061543.png", "https://image.prepladder.com/content/z4RW6KyXkKO6c02veDnF1740061594.png", "https://image.prepladder.com/content/iZ6H7pe1eIu0SH0wbErg1740061634.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4ZbZkt5ouPOpSzsr6fBX1746796012.mp3", "video": ""}, {"text": "A 45-year-old man with metastatic colorectal cancer is diagnosed with an acute DVT of the left leg. He had an episode of upper GI bleed 2 days ago. His lab results show a platelet count of 40,000/μL and an INR of 1.8. Which of the following is the most appropriate management strategy for preventing pulmonary embolism in this patient?", "options": [{"label": "A", "text": "Start anticoagulation with LMWH", "correct": false}, {"label": "B", "text": "Place a permanent IVC filter", "correct": false}, {"label": "C", "text": "Place a retrievable IVC filter", "correct": true}, {"label": "D", "text": "Start anticoagulation with UFH", "correct": false}], "correct_answer": "C. Place a retrievable IVC filter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mgwjMcCADRRIPsUZen5G1740060835.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IVC Filters:</strong></p>\n<p>Mechanical devices designed to prevent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> by trapping large clots in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"237b2a1dfa1692777200a074fd1072\">thromboembolism</span> despite adequate anticoagulation</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> in a patient with contraindications to anticoagulation</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> and resultant <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</li>\n<li>Complications of anticoagulation</li>\n<li>Propagating <span class=\"customMeta\" data-dictid=\"dae3263b2716927771896cfc9f45c8\">iliofemoral</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> in anticoagulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two main types of <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> filters:</p>\n<ul>\n<li><strong>Permanent filters:</strong> Designed for lifelong use</li>\n<li><strong>Retrievable (temporary) filters:</strong> Can be removed when no longer needed\n\t\t\t\t<ul>\n<li>Retrievable filters offer the flexibility of removal once the risk of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> has decreased or <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> becomes feasible.</li>\n<li>This approach helps <span class=\"customMeta\" data-dictid=\"a3b8e7d7ec1692777192646b2c8f69\">mitigate</span> the long-term complications associated with permanent filters.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications of Retrievable <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> Filter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prophylactic placement in high-risk trauma patients (orthopedic, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord patients)</li>\n<li>Short-term duration, <span class=\"customMeta\" data-dictid=\"c9f33964851692777185b94f619862\">contraindication</span> to <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> therapy</li>\n<li>Protection during <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"78e1197ee31692777200fa8819cf74\">thrombolytic</span> therapy</li>\n<li>Extensive iliocaval thrombosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Migration or <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> of the filter</li>\n<li>Fracture of the filter</li>\n<li>Perforation of the <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> or adjacent structures</li>\n<li>IVC thrombosis</li>\n<li>Post-thrombotic syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DRmKmGo0iEt8p6wZ5gP61746795851.mp3", "video": ""}, {"text": "A 45-year-old man with a history of colorectal cancer underwent surgery 3 weeks ago and is now presenting with complaints of left leg swelling and pain for 3 days. His left calf is 4 cm larger than the right. Using Wells' criteria for DVT, what is his pre-test probability score and risk category?", "options": [{"label": "A", "text": "2 points; Moderate risk", "correct": false}, {"label": "B", "text": "5 points; High risk", "correct": false}, {"label": "C", "text": "3 points; Moderate risk", "correct": false}, {"label": "D", "text": "4 points; High risk", "correct": true}], "correct_answer": "D. 4 points; High risk", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb trauma or surgery or <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> in a <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> cast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bedridden for &gt;3 days or surgery in the last 4 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenderness along the line of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> or popliteal veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Entire limb swollen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calf &gt;3 cm larger <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> than another side 10 cm below the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> tuberosity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pitting oedema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins (not <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Previous DVT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignancy (including treatment up to 6 months ago)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intravenous drug abuse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternative diagnosis more likely than DVT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-2</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sfa2AiQWPzZ1QPDRoDqf1746106058.mp3", "video": ""}, {"text": "A 52-year-old male presents with a swollen, painful left calf that developed over the past two days. He reports no history of trauma, surgery, or prolonged immobility. Physical examination reveals a warm, erythematous, and tender left calf. Which of the following clinical features is most specific for diagnosing deep vein thrombosis?", "options": [{"label": "A", "text": "Calf pain on dorsiflexion of the foot", "correct": false}, {"label": "B", "text": "Asymmetrical calf swelling", "correct": false}, {"label": "C", "text": "Pain that worsens with leg elevation", "correct": false}, {"label": "D", "text": "Localized tenderness along the course of the deep veins", "correct": true}], "correct_answer": "D. Localized tenderness along the course of the deep veins", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8yP5VnAJKtJ76oGIshLw1740060687.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specific for DVT; indicates <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> along the vein.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Asymmetrical calf swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common but not specific to DVT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">Erythema</span> and warmth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suggestive of <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. Pain in the affected limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur with or without movement; can indicate <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. Dilated <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May indicate <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> due to deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. Homans' sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-specific; <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">Passive</span> forceful <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of the foot with extended knee will cause <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the calf.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Mose’s sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painful response to gentle squeezing of the lower calf from side-to-side.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Neuhof's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thickening and deep <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the calf muscles upon palpation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9. <span class=\"customMeta\" data-dictid=\"34a7bc9de21692777195df390d3e9e\">Phlegmasia</span> <span class=\"customMeta\" data-dictid=\"455facf7ef169277718133da1f91e2\">Alba</span> Dolens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DVT of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> causes painful <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the leg with lymphangitis, which further increases <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (white leg).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10. <span class=\"customMeta\" data-dictid=\"34a7bc9de21692777195df390d3e9e\">Phlegmasia</span> Caerulea Dolens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensive <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> in <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> veins leading to a blue leg with possible <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> or infarction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Umb5TcKff5zMh2uY2yR41746795536.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 36 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?", "options": [{"label": "A", "text": "VAC", "correct": true}, {"label": "B", "text": "Normal saline soaked gauze", "correct": false}, {"label": "C", "text": "Prefer closure after laparotomy", "correct": false}, {"label": "D", "text": "Antibiotic soaked gauze", "correct": false}], "correct_answer": "A. VAC", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effectiveness in Open Abdomen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAC Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Highly effective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces infection, removes fluids, aids healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">Saline</span> Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keeps wound moist but does not actively remove exudates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">Closure</span> After Laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not preferred in contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome &amp; infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic-Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not provide <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> drainage</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "11", "correct": false}, {"label": "B", "text": "12", "correct": false}, {"label": "C", "text": "10", "correct": false}, {"label": "D", "text": "9", "correct": true}], "correct_answer": "D. 9", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:441px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient's Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion withdrawal from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"e37b435fd416927771886af66a9675\">GCS</span> Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 + 4 + 3</strong> = <strong>9</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To voice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structures are preserved during radical neck dissection?", "options": [{"label": "A", "text": "Digastric muscle", "correct": true}, {"label": "B", "text": "Sternocleidomastoid muscle", "correct": false}, {"label": "C", "text": "Spinal accessory nerve", "correct": false}, {"label": "D", "text": "Ipsilateral cervical lymph nodes", "correct": false}], "correct_answer": "A. Digastric muscle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A.\n<table>\n<thead>\n<tr>\n<td>\n<p><strong>Type of Radical Neck Dissection</strong></p>\n</td>\n<td>\n<p><strong>Structures Removed</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (RND)</p>\n</td>\n<td rowspan=\"4\">\n<ul>\n<li>All <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the neck</li>\n<li>Sternocleidomastoid muscle</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein</li>\n<li>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve</li>\n<li>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> (optional)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td>\n<p>Modified Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (MRND)</p>\n</td>\n<td>\n<ul>\n<li>Selective <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the neck</li>\n<li>Sternocleidomastoid muscle</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (optional)</li>\n<li>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve (preserved or partially preserved)</li>\n<li>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> (optional)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\">\n<p>Selective Neck Dissection</p>\n</td>\n<td>\n<p>Selective <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the neck based on the level of involvement</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Preservation of other structures based on the extent of disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 13 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 52-year-old female presents with a two-month history of persistent itching, redness, and scaling of the right nipple, unresponsive to moisturizing creams. Physical examination reveals erythema and crusting of the nipple and areola without palpable breast lumps. The image of her right breast is given below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Paget disease of the nipple", "correct": true}, {"label": "B", "text": "Scirrhous tumor", "correct": false}, {"label": "C", "text": "Ductal papilloma", "correct": false}, {"label": "D", "text": "Inflammatory carcinoma", "correct": false}], "correct_answer": "A. Paget disease of the nipple", "question_images": ["https://image.prepladder.com/content/81F6UaTjyhqKOC7mpOmM1739869368.png"], "explanation_images": ["https://image.prepladder.com/content/fdM61neVkeJvl69cQxsM1739869410.png", "https://image.prepladder.com/content/yRnTBLFySw5UhZNgggOT1739869446.png", "https://image.prepladder.com/content/RANYIqbuhKr0AWggSmUY1739869495.png", "https://image.prepladder.com/content/Ouo2TiOApZPEX438l44f1739869536.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Possible Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nipple discharge</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://surgicalimages.arizona.edu/medical-image-vocabulary/intraductal-papilloma\" data-tags=\"\" height=\"537\" src=\"https://image.prepladder.com/content/fdM61neVkeJvl69cQxsM1739869410.png\" width=\"715\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discharge from a single <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> orifice</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Papilloma <strong>(Option C)</strong> or other underlying ductal disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paget disease of the nipple</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lily Chu, National Naval Medical Center Bethesda\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Paget_Disese_of_the_Nipple.jpg\" data-tags=\"\" height=\"537\" src=\"https://image.prepladder.com/content/yRnTBLFySw5UhZNgggOT1739869446.png\" width=\"722\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appears as a psoriatic <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> starting on the <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> and <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> to the <span class=\"customMeta\" data-dictid=\"f206b2cc1e1692777182d953d68475\">areola</span> and breast skin.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paget disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin dimpling</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Naraynsingh, Vijay &amp; Jarvis, Johnathan &amp; Milne, David &amp; Shamir, Cawich &amp; Harnanan, Dave &amp; Singh, Yardesh &amp; Islam, Shariful.\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Pushing-lump-inferiorly-produces-concavity-of-the-overlying-skin-arrows_fig1_357114040\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/RANYIqbuhKr0AWggSmUY1739869495.png\" width=\"3929\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Traction on Cooper ligaments by a <span class=\"customMeta\" data-dictid=\"332d664c4816927771983dedc4e088\">scirrhous</span> tumor</li>\n<li>Best seen with angled <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> lighting during the <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of the arms upward.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scirrhous tumor <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peau d’orange (skin of the orange)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Soroush Seifirad\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://www.wikidoc.org/index.php/File:Peau_d%E2%80%99_orange_Appearance_in_Breast_cancer.jpg\" data-tags=\"\" height=\"537\" src=\"https://image.prepladder.com/content/Ouo2TiOApZPEX438l44f1739869536.png\" width=\"554\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Edema of the breast skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Option D)</strong></li>\n<li>Lymphatic blockage</li>\n<li>Mastitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/X3v9UtdDnSy51aPKb6Cn1744550787.mp3", "video": ""}, {"text": "A 45-year-old woman diagnosed with early-stage breast cancer opts for surgery that involves the removal of the entire breast, including the nipple and areola, but not the axillary lymph nodes. Which type of mastectomy is she likely undergoing?", "options": [{"label": "A", "text": "Total (Simple) Mastectomy", "correct": true}, {"label": "B", "text": "Modified Radical Mastectomy", "correct": false}, {"label": "C", "text": "Radical Mastectomy", "correct": false}, {"label": "D", "text": "Extended Mastectomy", "correct": false}], "correct_answer": "A. Total (Simple) Mastectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structures removed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple/Total <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> (Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>En bloc removal of</p>\n<ul>\n<li>Nipple</li>\n<li>Areola</li>\n<li>Breast mass</li>\n<li>Skin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extended <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> (Total <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">Mastectomy</span> with Axillary Dissection) (Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> <strong>+ </strong>removal of level I axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Halsted/Radical <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> (Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> <strong>+ </strong>removal of level I, II, III axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes <strong>+ </strong>excision of <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major and minor muscle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Radical Mastectomy(MRM) (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> <strong>+ </strong>removal of level I, II, III axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n\t\t\t \n\n\t\t\t<p><strong>Variants</strong> :</p>\n<ul>\n<li><strong>Auchincloss <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> : </strong>MRM</li>\n<li><strong>Patey’s modification</strong>: MRM <strong>+ </strong>excision of <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor</li>\n<li><strong>Scanlons modification</strong>: MRM <strong>+ </strong>division of <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor(removal and resuturing)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9CPbX8tKihEPuCx442SF1744555600.mp3", "video": ""}, {"text": "Which of the following conditions is not an absolute contraindication for breast-conserving surgery (BCS)?", "options": [{"label": "A", "text": "Prior radiation therapy to the chest wall or breast", "correct": false}, {"label": "B", "text": "Diffuse malignant microcalcifications", "correct": false}, {"label": "C", "text": "Stage IIB breast cancer", "correct": true}, {"label": "D", "text": "Pregnancy", "correct": false}], "correct_answer": "C. Stage IIB breast cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:599px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Absolute Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pregnancy <strong>(Option D ruled out</strong>) because after BCS postop <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> will be necessary which is not possible in case pregnancy.</li>\n<li>Multicentric Disease</li>\n<li>Diffuse malignant microcalcifications on mammogram suggests widespread disease, making complete <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with clear margins unlikely (<strong>Option B ruled out)</strong></li>\n<li>Prior Radiation Therapy to the Chest Wall or Breast cannot give radiation again, which is essential after BCS<strong>(Option A ruled out)</strong></li>\n<li>Extensive Positive Pathological Margins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Relative Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Active Connective Tissue Disease Involving the Skin (e.g., Scleroderma)</li>\n<li>Large tumor size relative to breast size or tumors greater than 5 cm</li>\n<li>Large <span class=\"customMeta\" data-dictid=\"83d07b3311169277719570ce3ddbbf\">pendulous</span> breast</li>\n<li>Centrally located tumor</li>\n<li>Extensive DCIS (often requires aggressive management, such as mastectomy, due to the risk of recurrence).</li>\n<li>Homozygous for ATM Mutation</li>\n<li>Known or Suspected Li-Fraumeni Syndrome (p53 Mutation)</li>\n<li>Known or Suspected Genetic Predisposition to Breast Cancer (e.g., BRCA1, BRCA2) - Prophylactic <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> is preferred for individuals with high genetic cancer risk to reduce the likelihood of developing breast cancer.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/f1C6979bTuJbsItzzqLk1749128184.mp3", "video": ""}, {"text": "Which of the following are components of the Van Nuys Prognostic Index (VNPI) for DCIS? Tumor size Margin status Histological grade Patient age", "options": [{"label": "A", "text": "1 &amp;amp; 2", "correct": false}, {"label": "B", "text": "1 &amp;amp; 3", "correct": false}, {"label": "C", "text": "1, 2 &amp;amp; 3", "correct": false}, {"label": "D", "text": "1, 2, 3 &amp;amp; 4", "correct": true}], "correct_answer": "D. 1, 2, 3 &amp; 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score 3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≤ 15 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16-40 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;40 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Margin Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-9 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;1 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Grade I/II</li>\n<li>Well-differentiated</li>\n<li>Necrosis absent</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Grade I/II</li>\n<li>Moderately differentiated</li>\n<li>Necrosis present</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Grade III</li>\n<li>Poorly differentiated</li>\n<li>Necrosis present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 61 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>40-60 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 39 years</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZVKELW0K8CMKui6bKRVE1744554464.mp3", "video": ""}, {"text": "Which of the following describes the basal type of breast malignancy?", "options": [{"label": "A", "text": "ER +, PR -, and HER2 +", "correct": false}, {"label": "B", "text": "ER -, PR -, and HER2 -", "correct": true}, {"label": "C", "text": "ER +, PR +, and HER2 +", "correct": false}, {"label": "D", "text": "ER -, PR -, and HER2 +", "correct": false}], "correct_answer": "B. ER -, PR -, and HER2 -", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ER Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>PR Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HER2 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ki-67 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally low grade, better prognosis, responsive to hormonal therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal B </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher grade, poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A, may require targeted HER2 therapy following status.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2-enriched</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive, higher grade, poor prognosis, requires targeted HER2 therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal-like</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes triple-negative breast cancer (TNBC), highly aggressive, no targeted hormonal therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Claudin-low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often associated with poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and aggressive behavior, typically lacks response to hormonal therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2elhOk51XeFkNE6DPaGk1744553464.mp3", "video": ""}, {"text": "A 55-year-old woman presents with a palpable breast lump. After imaging studies and a biopsy, the results show a tumor measuring 3.5 cm in the breast. The patient also has involvement of ipsilateral internal mammary lymph nodes, but no distant metastases are detected. Based on the TNM staging system, what is the appropriate stage for this breast cancer?", "options": [{"label": "A", "text": "T1 N2", "correct": false}, {"label": "B", "text": "T2 N1", "correct": false}, {"label": "C", "text": "T2 N2", "correct": true}, {"label": "D", "text": "T3 N1", "correct": false}], "correct_answer": "C. T2 N2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumor size (T)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary tumor cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No evidence of primary tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (DCIS, LCIS, or Paget's disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤ 2 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1mi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤ 1 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 1 mm but ≤ 5 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 5 mm but ≤ 10 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 10 mm but ≤ 20 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 2 cm but ≤ 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor of any size with direct extension to <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> or skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension to chest wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulceration or skin nodules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both T4a and T4b</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4d</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammatory breast cancer</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Node (N)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastases to movable <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> level I, II axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or clinically apparent internal mammary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes that are clinically fixed or matted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to internal mammary nodes without axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> nodes, or to <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to internal mammary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metastasis (M)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NRE82WKZUX1UsV38gKVG1744552991.mp3", "video": ""}, {"text": "A 45-year-old woman presents for her routine mammogram. She has no family history of breast cancer and no previous history of breast issues. A mammogram reveals a well-circumscribed, homogeneous lesion with characteristic benign features, such as a simple cyst with no suspicious calcifications or architectural distortions. Based on these findings, What is the appropriate BI-RADS category for this lesion?", "options": [{"label": "A", "text": "BI-RADS 1", "correct": false}, {"label": "B", "text": "BI-RADS 2", "correct": true}, {"label": "C", "text": "BI-RADS 3", "correct": false}, {"label": "D", "text": "BI-RADS 4", "correct": false}], "correct_answer": "B. BI-RADS 2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>BI-RADS Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Likelihood of Malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomplete</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Need additional <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> evaluation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Routine screening</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essentially 0%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Routine screening</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essentially 0%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Probably Benign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short-term follow-up (6 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 2%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious of Malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsy should be considered</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious: Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>_</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2% to ≤ 10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious: Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>_</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 10% to ≤ 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious: High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>_</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 50% to ≤ 95%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly Suggestive of Malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appropriate action should be taken</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 95%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Known Biopsy-Proven Malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appropriate action should be taken</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/o2clznwMJaP1PTuzjQGP1744552783.mp3", "video": ""}, {"text": "Match the following: Biopsy Feature 1. FNAC a. Evaluation of cellular fibroadenoma 2. Core-needle biopsy b. Assessment of suspicious lymph nodes 3. Excisional biopsy c. Sampling solid masses, calcifications, and densities identified on imaging", "options": [{"label": "A", "text": "1-b,2-c,3-a", "correct": true}, {"label": "B", "text": "1-a,2-b,3-c", "correct": false}, {"label": "C", "text": "1-c,2-b,3-a", "correct": false}, {"label": "D", "text": "1-b,2-a,3-c", "correct": false}], "correct_answer": "A. 1-b,2-c,3-a", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biopsy Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> (FNA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>22-gauge needle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Evaluation of secondaries</li>\n<li>Assessment of suspicious <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between noninvasive and <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> lesions if <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> cells are found</li>\n<li>Requires core needle <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (CNB) for <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> diagnosis</li>\n<li>May yield inconclusive results</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Core Needle <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> (CNB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Preferred method</li>\n<li>Imaging guidance</li>\n<li>Needle: 8 to 14-gauge</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sampling solid masses, calcifications, and densities identified on imaging</li>\n<li>Used to obtain <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> subtype, grade, and <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> status of detected malignancies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small sample size requires careful interpretation</li>\n<li>Inconclusive results may necessitate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> excision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Excisional Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Entire <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> removed for diagnosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used when CNB results are inconclusive or when there is <span class=\"customMeta\" data-dictid=\"70f12ce92716927771869945804c95\">discordance</span> with <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> findings</li>\n<li>Evaluation of <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> ductal <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (ADH) or <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> fibroadenoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Costly</li>\n<li>Delays <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment</li>\n<li>More invasive</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cW4osOQYHFdghcOkLkgO1744552575.mp3", "video": ""}, {"text": "A 48-year-old female underwent a lumpectomy for a 2 cm invasive ductal carcinoma in her right breast. Post-surgery pathology revealed positive margins, indicating residual cancerous tissue. Which of the following investigations is most suitable to check for residual cancer tissues?", "options": [{"label": "A", "text": "MRI", "correct": true}, {"label": "B", "text": "USG", "correct": false}, {"label": "C", "text": "Mammography", "correct": false}, {"label": "D", "text": "Repeat the biopsy", "correct": false}], "correct_answer": "A. MRI", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:597px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Determines if a <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> detected by <span class=\"customMeta\" data-dictid=\"a1672bc5881692777191cad63bc4a8\">mammography</span> is solid or cystic</li>\n<li>Discriminating lesions in dense breasts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not effective as a standalone breast cancer screening tool</li>\n<li>Highly dependent on the operator performing the scan</li>\n<li>Lack of standardized screening protocols</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UfB6Yep6I0LZla2nnVh71744552412.mp3", "video": ""}, {"text": "A lesion was found in a routine mammogram of a 52-year-old asymptomatic woman. Which of the following statements regarding mammogram findings is false?", "options": [{"label": "A", "text": "If the density of the lesion is high, it is mostly malignant", "correct": false}, {"label": "B", "text": "Architectural distortion is usually present in benign lesions", "correct": true}, {"label": "C", "text": "Calcification in benign lesions is diffuse", "correct": false}, {"label": "D", "text": "Margins are well-circumscribed in benign lesions", "correct": false}], "correct_answer": "B. Architectural distortion is usually present in benign lesions", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Benign Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Malignant Lesions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Round, oval, lobular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Margins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Circumscribed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microlobulated, obscured, indistinct, spiculated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Density</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low to intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate to high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution of Calcifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Randomly distributed, diffuse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grouped, clustered, fine linear, branching, segmental</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Architectural Distortion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often present</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose of Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Detect <span class=\"customMeta\" data-dictid=\"c8d9b6cbbb1692777194c4bc31f01f\">occult</span> breast cancer in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> women</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early detection</li>\n<li>Reduced mortality</li>\n<li>High sensitivity and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> in older women (fatty breast tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Screening expenses</li>\n<li>False positives</li>\n<li>Additional workups</li>\n<li>Anxiety</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(USPSTF) Recommendations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biennial screening for women 50-74 years</li>\n<li>Recommended against screening for women 40-49 years and &gt;75 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>American Cancer Society Recommendations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Annual screening for women &gt;40 years in good health</li>\n<li>MRI screening for younger women with high risk (20% lifetime risk)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FopX7HdXpYZDeR0ymey41744551780.mp3", "video": ""}, {"text": "A 45-year-old female presents with a painless lump in her right breast, noticed during a self-examination two weeks ago. Which of the following tests has the maximum accuracy?", "options": [{"label": "A", "text": "FNAC", "correct": false}, {"label": "B", "text": "Core biopsy", "correct": false}, {"label": "C", "text": "Mammography", "correct": false}, {"label": "D", "text": "Triple assessment", "correct": true}], "correct_answer": "D. Triple assessment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Clinical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Objective:</strong> Identify lumps, skin changes, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> discharge, or lymphadenopathy.</p>\n<p><strong>Procedure:</strong> <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">Palpation</span> of breasts and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methods:</strong></p>\n<ul>\n<li><strong>Mammography:</strong> Preferred for women over 40.</li>\n<li><strong>Ultrasound:</strong> Used in younger women or for further evaluation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>FNA:</strong> Minimally invasive; used for <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> lesions.</li>\n<li><strong>Core Needle:</strong> Preferred for solid masses.</li>\n<li><strong>Excisional:</strong> Removes lump for examination.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/y8d0xCYwZeD1p98XG4qo1744551196.mp3", "video": ""}, {"text": "Which of the following statements about lymphatic drainage of the breast is true?", "options": [{"label": "A", "text": "Level III lymph nodes are located lateral to the pectoralis minor muscle.", "correct": false}, {"label": "B", "text": "Lymphatic drainage from the breast is directed to the subclavian lymph nodes.", "correct": false}, {"label": "C", "text": "Level I lymph nodes are also known as rotter’s nodes.", "correct": false}, {"label": "D", "text": "Level II lymph nodes are located posterior to the pectoralis major", "correct": true}], "correct_answer": "D. Level II lymph nodes are located posterior to the pectoralis major", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d8KOMK40XymCYxaYW6sb1739869011.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Level of node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> border of <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level II(Rotter/Interpectoral nodes)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior as well as <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor muscle and include <span class=\"customMeta\" data-dictid=\"20f97f4f831692777199927fc4f725\">subclavicular</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qV3VKX6DBwJMfo2OaK3L1744547181.mp3", "video": ""}, {"text": "Arrange the following in decreasing order of frequency of metastasis in breast cancer", "options": [{"label": "A", "text": "Lumbar vertebrae&amp;gt; femur&amp;gt; thoracic vertebrae&amp;gt; ribs&amp;gt; skull", "correct": true}, {"label": "B", "text": "Lumbar vertebrae&amp;gt; thoracic vertebrae&amp;gt; ribs&amp;gt; skull&amp;gt; femur", "correct": false}, {"label": "C", "text": "Thoracic vertebrae&amp;gt;lumbar vertebrae&amp;gt; ribs&amp;gt; skull&amp;gt; femur", "correct": false}, {"label": "D", "text": "Thoracic vertebrae&amp;gt; femur&amp;gt; lumbar vertebrae&amp;gt; ribs&amp;gt; skull", "correct": false}], "correct_answer": "A. Lumbar vertebrae&gt; femur&gt; thoracic vertebrae&gt; ribs&gt; skull", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Spread of breast cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tumors invade nearby tissues (skin, chest wall).</li>\n<li>Inflammatory breast cancer blocks <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels(subdermal /superficial), causing <span class=\"customMeta\" data-dictid=\"8d04c26f1716927771951f6f59d3d6\">peau</span> d'orange, often without a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass, complicating detection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cancer cells spread to nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Positive nodes indicate worse prognosis</li>\n<li>Axillary nodes (75% drainage)- Axillary nodes: Level I (lateral), Level II (posterior), Level III (medial).</li>\n<li>Lymph nodes closest to the tumor (level I) are usually affected first, followed by those in the middle (level II) and then the top of the <span class=\"customMeta\" data-dictid=\"c4a157dc7f1692777182f94ccb5978\">armpit</span> (level III).</li>\n<li>Internal mammary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes (5% drainage) - secondary route in 20% of cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematogenous Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cancer cells enter the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> indicating stage IV cancer.</li>\n<li>Metastasising to distant organs in frequency :\n\t\t\t\t<ul>\n<li>Bones&gt; lungs&gt; liver&gt; brain</li>\n</ul>\n</li>\n<li>Among bones frequency:\n\t\t\t\t<ul>\n<li>Lumbar vertebrae&gt; femur&gt; <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> vertebrae&gt; ribs&gt; skull <strong>(Option A)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multifocal Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cancers may appear as multiple independent <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> within the same breast or different quadrants</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> lobular carcinoma.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/N81YNGHfFfqmRPIfjppU1744550360.mp3", "video": ""}, {"text": "A 55-year-old woman is diagnosed with breast cancer. The pathology report shows a 2.5 cm tumor with positive lymph nodes. The tumor is ER-positive, PR-positive, and HER2-negative. Which of the following statements is most accurate regarding her prognosis and treatment?", "options": [{"label": "A", "text": "The tumor size and lymph node status suggest a favorable prognosis", "correct": false}, {"label": "B", "text": "The hormone receptor status indicates the tumor will not respond to endocrine therapy", "correct": false}, {"label": "C", "text": "The absence of HER2 overexpression means targeted therapies are the primary treatment option", "correct": false}, {"label": "D", "text": "The ER-positive status suggests a better prognosis and responsiveness to endocrine therapy", "correct": true}], "correct_answer": "D. The ER-positive status suggests a better prognosis and responsiveness to endocrine therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histologic Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (IDC): <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">Prognosis</span> varies by <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> and molecular markers.</li>\n<li>Invasive Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (ILC): <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">Intermediate</span> prognosis.</li>\n<li>Tubular and <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> Carcinomas: Best prognosis.</li>\n<li>Basal-like Breast Cancer: Aggressive, triple-negative, no targeted treatments.</li>\n<li>Other Subtypes: Medullary, cribriform, papillary, <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> cystic, <span class=\"customMeta\" data-dictid=\"03f835a65f169277719239326cc094\">metaplastic</span> carcinomas vary in prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Size &amp; <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pathologic <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> (tumor size, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes) guides <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and treatment.</li>\n<li>Larger tumors and positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes = worse prognosis. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hormone Receptors (ER, PR): ER-positive = better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> <strong>(Option D)</strong>, responsive to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy. <strong>(Option B)</strong></li>\n<li>HER-2 Status: HER-2 positive = aggressive but treatable with targeted therapies.<strong> </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Patient factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Younger, particularly <span class=\"customMeta\" data-dictid=\"a9f4834def16927771962441e4ed98\">premenopausal</span> women, may have higher local <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates post-surgery, but radiation therapy can reduce this risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BRCA Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally more aggressive and associated with poorer prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A strong family history may indicate inherited <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> and potentially worse prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prior Breast Cancer History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Previous breast cancer can negatively influence the <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> of a new diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obesity and <span class=\"customMeta\" data-dictid=\"66aad2dcdb169277719098b25eec8c\">inactivity</span> are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to increased <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk and may affect overall prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Adherence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-compliance can worsen prognosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pNkCcm5joytanGSv7sQa1744549955.mp3", "video": ""}, {"text": "A 38-year-old premenopausal woman is diagnosed with Lobular Carcinoma In Situ (LCIS) after a breast biopsy. She opts for chemoprevention as her management strategy. Her doctor discusses various medication options with her. Which of the following statements about chemoprevention for LCIS is correct?", "options": [{"label": "A", "text": "Chemoprevention eliminates the risk of developing breast cancer", "correct": false}, {"label": "B", "text": "Tamoxifen reduces breast cancer risk by 25% over 5 years", "correct": false}, {"label": "C", "text": "Chemoprevention is only effective for the ipsilateral breast", "correct": false}, {"label": "D", "text": "Tamoxifen reduces breast cancer risk by 56% over 5 years", "correct": true}], "correct_answer": "D. Tamoxifen reduces breast cancer risk by 56% over 5 years", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<thead>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Overview</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histologic marker of increased breast cancer risk, not true cancer.</li>\n<li>It involves an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> of cells within the lobules of the breast without invasion through the basement membrane.</li>\n<li>Subsequent <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> cancers are predominantly ductal, not lobular</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Characteristics</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs mainly in younger, <span class=\"customMeta\" data-dictid=\"a9f4834def16927771962441e4ed98\">premenopausal</span> women</li>\n<li>Typically an incidental finding during biopsy</li>\n<li>No <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> masses or suspicious mammographic microcalcifications</li>\n<li>Bilateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Risk</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>21.4% chance of developing <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> over 35 years</li>\n<li>7:1 <span class=\"customMeta\" data-dictid=\"a89aef1d191692777197a9bf8a34bf\">risk ratio</span> for <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> breast cancer</li>\n<li>50% of subsequent carcinomas in <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> breast</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Management</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Close observation</li>\n<li>Chemoprevention\n\t\t\t\t<ul>\n<li>Medications: Tamoxifen, Raloxifene, or Arimidex</li>\n<li><strong>Tamoxifen reduces risk by 56% over 5 years </strong></li>\n</ul>\n</li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> (if surgery chosen prophylactically)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lifelong breast cancer risk affecting both breasts equally<strong> </strong></li>\n<li>Risk slightly less than 1% per year</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DcNVuwDX2drxduUuhSgn1744549399.mp3", "video": ""}, {"text": "A 52-year-old woman undergoes a routine mammogram, which reveals clustered calcifications in her left breast. Further investigation confirms the diagnosis of ductal carcinoma in situ (DCIS). The lesion is small, low-grade, and has clear margins. The patient expresses a strong desire to preserve her breast if possible. What is the most appropriate initial treatment approach?", "options": [{"label": "A", "text": "Hormonal therapy alone", "correct": false}, {"label": "B", "text": "Lumpectomy with radiation therapy", "correct": false}, {"label": "C", "text": "Lumpectomy alone", "correct": true}, {"label": "D", "text": "Systemic chemotherapy", "correct": false}], "correct_answer": "C. Lumpectomy alone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-invasive breast cancer within milk ducts</li>\n<li>Does not spread beyond the ductal <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> into the surrounding tissue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily through <span class=\"customMeta\" data-dictid=\"a75f64999d1692777191c1a2d3c0b7\">mammogram</span> (clustered calcifications)</li>\n<li>Less common: <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass, calcifications with density, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> discharge</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of DCIS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Papillary (Low grade)</li>\n<li>Cribriform (Low grade)</li>\n<li>Solid (High grade)</li>\n<li>Comedo (High grade)</li>\n<li>Mixed morphology- Most DCIS lesions have</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mastectomy\n\t\t\t\t<ul>\n<li>Near-certain cure rate (98-99% survival)</li>\n<li>1-2% lifetime risk of local recurrence</li>\n</ul>\n</li>\n<li>Breast-conserving surgery (lumpectomy) with radiation\n\t\t\t\t<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk compared to <span class=\"customMeta\" data-dictid=\"bbe59e177a169277719159a9521c38\">lumpectomy</span> alone <strong>(Option B)</strong></li>\n</ul>\n</li>\n<li>Breast-conserving surgery alone\n\t\t\t\t<ul>\n<li>For specific low-risk cases<strong> (Option C)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adjuvant Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hormonal therapy (e.g., Tamoxifen) <strong> </strong><strong>(Option A)</strong></li>\n<li>Sentinel <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (SLNB)\n\t\t\t\t<ul>\n<li>Recommended for <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> patients</li>\n<li>Considered in specific breast-conserving surgery cases</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sHf0qdrPptrdrjuuc2UM1744548864.mp3", "video": ""}, {"text": "All of the following are invasive carcinomas except:", "options": [{"label": "A", "text": "Ductal carcinoma", "correct": false}, {"label": "B", "text": "Lobular carcinoma", "correct": false}, {"label": "C", "text": "Tubular carcinoma", "correct": false}, {"label": "D", "text": "Fibroadenoma", "correct": true}], "correct_answer": "D. Fibroadenoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Invasive Carcinomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Invasive <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> of No Special Type (NST)</strong></li>\n<li><strong>Special Subtypes of <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> Carcinoma:</strong>\n<ul>\n<li>Invasive Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (Option A)</li>\n<li>Invasive Lobular Carcinoma: Classic, solid, alveolar, pleomorphic, and tubulolobular variants. (Option B)</li>\n<li>Tubular Carcinoma</li>\n<li>Cribriform Carcinoma</li>\n<li>Mucinous Carcinoma: Characterized by <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> production, good prognosis.</li>\n<li>Medullary Carcinoma: <span class=\"customMeta\" data-dictid=\"909f76d0b416927771915529b6f043\">Lymphoplasmacytic</span> infiltrate, associated with BRCA1 mutations. (Option C)</li>\n<li>Metaplastic Carcinoma</li>\n<li>Invasive Micropapillary Carcinoma</li>\n<li>Carcinomas with <span class=\"customMeta\" data-dictid=\"495f6155fb1692777181ce9121d548\">Apocrine</span> Differentiation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precursor Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">In Situ</span> (DCIS)</li>\n<li>Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">In Situ</span> (LCIS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benign Epithelial Proliferations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibroadenomas (Option D)</li>\n<li>Phyllodes Tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare Tumor Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> Carcinoma</li>\n<li>Secretory Carcinoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QFmQ1wqGfkpRCjcvtCcQ1744548559.mp3", "video": ""}, {"text": "Which of the following is the most common model used for breast cancer risk assessment?", "options": [{"label": "A", "text": "Gail Model", "correct": true}, {"label": "B", "text": "Framingham Risk Score", "correct": false}, {"label": "C", "text": "ASCVD Risk Estimator", "correct": false}, {"label": "D", "text": "QRISK3", "correct": false}], "correct_answer": "A. Gail Model", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gail model</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clause model</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most commonly used</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More information about family history</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absolute risk estimation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relative risk estimation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is assessed with</p>\n<ul>\n<li>Age at menarche</li>\n<li>Number of 1st°relatives with breast carcinoma</li>\n<li>Age at first life birth</li>\n<li>Number of breast biopsies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is assessed with</p>\n<ul>\n<li>1st° and 2nd° relatives with breast cancer</li>\n<li>Age of diagnosis of relatives</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tyfjkMfVHRlUKBFBQAnQ1744548366.mp3", "video": ""}, {"text": "Which of the following statements about breast cancer risk factors is true?", "options": [{"label": "A", "text": "The median age of breast cancer presentation is 60 years in India", "correct": false}, {"label": "B", "text": "The relative risk of Papillomatosis is 8-10", "correct": false}, {"label": "C", "text": "Relative Risk for breast cancer in 1st-degree relative is 3", "correct": false}, {"label": "D", "text": "Early onset of menstruation increases breast cancer risk.", "correct": true}], "correct_answer": "D. Early onset of menstruation increases breast cancer risk.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Modifiable risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-modifiable risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obesity: <span class=\"customMeta\" data-dictid=\"765e9149d01692777183c3989c6590\">BMI</span> &gt; 30 (RR= 1.29)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n<ul>\n<li>Median age at presentation is 60 years in the West(UK,USA) While it is around 48 years in low/middle-income nations such as India.(Option A)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nulliparous women or first pregnancy after 35 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sex</strong></p>\n<ul>\n<li>Female sex is a risk factor</li>\n<li>Male sex accounts for 0.5-1% of all breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breastfeeding is a protective factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethnicity</strong></p>\n<p><strong>American white, African-American Parsi in India</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use of Hormonal Replacement Therapy (HRT) &gt;10 years (RR= 1.2)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Family history of breast cancer</strong></p>\n<ul>\n<li>1 first degree relative RR= 2(option C)</li>\n<li>2 first-degree relative RR= 3</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tobacco use (RR=1.07-1.14)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic predisposition</strong></p>\n<p>BRCA1 and BRCA2 mutations account for 70% of <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> breast cancers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alcohol Consumption (RR = 1.05-1.32)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Menarche(&lt;12years)</strong></p>\n<p>Increases by around 5% for each year earlier <span class=\"customMeta\" data-dictid=\"af76284ec71692777192c7c84b5dad\">menstruation</span> begins RR=1.19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation exposure (RR=6)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Menopause(&gt;55years)</strong></p>\n<p>Increases by about 3% for each year later <span class=\"customMeta\" data-dictid=\"516cc2e77d169277719213e7926b59\">menopause</span> begins RR=1.12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age at first child</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>&lt;20years - Less risk</li>\n<li>&gt;35years - High risk</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-risk breast lesions</strong></p>\n<ul>\n<li>Complex <span class=\"customMeta\" data-dictid=\"633e6ef4ca169277720219ea037f2c\">fibroadenoma</span> RR=3</li>\n<li>Papillomatosis RR=3(Option B)</li>\n<li>Ductal and lobular <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> RR= 5</li>\n<li>Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> RR= 8-10</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9qrdJZ8TGqZwo5bLYVxx1744548060.mp3", "video": ""}, {"text": "Which of the following is the most common cause of bloody nipple discharge?", "options": [{"label": "A", "text": "Breast cancer", "correct": false}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Intraductal papilloma", "correct": true}, {"label": "D", "text": "Duct Ectasia", "correct": false}], "correct_answer": "C. Intraductal papilloma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">Nipple</span> Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bloody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">Papilloma</span> (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrocystic Disease (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greenish/Blackish</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Milk (Galactorrhea)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological (e.g., Pregnancy, Lactation)</li>\n<li>Hyperprolactinemia (e.g., <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">Pituitary</span> Adenoma, Hypothyroidism)</li>\n<li>Medications (e.g., Antipsychotics, Antidepressants, Oral Contraceptives)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purulent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breast Abscess</li>\n<li>Mastitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rG9MnwXGNGnKYaKnAcpw1744547791.mp3", "video": ""}, {"text": "What is the primary arterial supply to the superior part of the breast?", "options": [{"label": "A", "text": "Internal thoracic artery", "correct": false}, {"label": "B", "text": "Lateral thoracic artery", "correct": false}, {"label": "C", "text": "Thoracoacromial artery", "correct": true}, {"label": "D", "text": "Intercostal artery", "correct": false}], "correct_answer": "C. Thoracoacromial artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cA0A8GNMSa9Sxa4rTxdg1739869247.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Areas Supplied</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial and central parts of the breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral aspect of the breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracoacromial artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior part of the breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> aspects of the breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper part of the breast (limited supply)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subscapular artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower part of the breast</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2GKu5G888CN0YOBf9tky1744547521.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following are indications for adjuvant chemotherapy in breast cancer? Post-surgery eradication of microscopic residual disease in high-risk patients Inflammatory breast cancer. HER2-positive breast cancer in combination with HER2-targeted therapy Triple-negative breast cancer Enabling breast-conserving surgery by reducing tumor size.", "options": [{"label": "A", "text": "1, 3, and 5 are correct", "correct": false}, {"label": "B", "text": "2, 3, and 5 are correct", "correct": false}, {"label": "C", "text": "2, 4, and 5 are correct", "correct": false}, {"label": "D", "text": "1, 3, and 4 are correct", "correct": true}], "correct_answer": "D. 1, 3, and 4 are correct", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anthracyclines</strong></p>\n<ul>\n<li>Doxorubicin</li>\n<li>Epirubicin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neoadjuvant and <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> therapy; broad efficacy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Taxanes</strong></p>\n<ul>\n<li>Paclitaxel</li>\n<li>Docetaxel</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adjuvant therapy and metastatic disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkylating Agents</strong></p>\n<ul>\n<li>Cyclophosphamide</li>\n<li>Ifosfamide</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination regimens for early and metastatic cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antimetabolites</strong></p>\n<ul>\n<li>5-Fluorouracil</li>\n<li>Methotrexate</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often combined in regimens for early-stage cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Platinum-Based Agents</strong></p>\n<ul>\n<li>Carboplatin</li>\n<li>Cisplatin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Triple-negative breast cancer, BRCA mutations</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2dkz5yKoH0SZvDqZjB5i1744867355.mp3", "video": ""}, {"text": "A 28-year-old lactating mother presents with fever, breast pain, swelling, and a tender, erythematous area on her left breast. Ultrasonography confirms the presence of a pus-filled cavity. What would be the initial treatment in this scenario?", "options": [{"label": "A", "text": "Close Observation", "correct": false}, {"label": "B", "text": "Antibiotics and breast emptying", "correct": true}, {"label": "C", "text": "Hormonal therapy", "correct": false}, {"label": "D", "text": "Surgical excision", "correct": false}], "correct_answer": "B. Antibiotics and breast emptying", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess</strong><strong>: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess:</strong><strong> </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes and Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lactation:\n\t\t\t\t<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li>Non-Lactation:\n\t\t\t\t<ul>\n<li>Often in<strong> </strong><strong>nulliparous women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis</strong><strong>.</strong></li>\n<li><strong>Smoking and diabetes</strong><strong> </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs and symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ultrasonography:\n\t\t\t\t<ul>\n<li>Detects cellulitis, <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision.</li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews, culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li>Non-Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/d377oyGhFvm1XtjCVydb1744871365.mp3", "video": ""}, {"text": "A 35-year-old lactating woman presents with a rapidly progressing, painful, and warm swelling involving her entire left breast. She was diagnosed with inflammatory breast cancer. Which of the following statements are correct regarding her condition?", "options": [{"label": "A", "text": "The prognosis is bad", "correct": false}, {"label": "B", "text": "Stage III B carcinoma (T4d)", "correct": false}, {"label": "C", "text": "Can be mistaken for acute mastitis", "correct": false}, {"label": "D", "text": "All are true", "correct": true}], "correct_answer": "D. All are true", "question_images": ["https://image.prepladder.com/content/6M6NRU6XwYLeML9vmy3D1739869896.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most aggressive</li>\n<li>Rapidly progressive</li>\n<li><strong>Worst prognosis</strong></li>\n<li>Short duration</li>\n<li>Rapidly metastasizes to chest wall, bone, and lungs</li>\n<li><strong>Always stage III B <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (T4d)</strong></li>\n<li>Common in lactating women or pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Synonyms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lactating carcinoma/Mastitis carcinomatosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diffuse, painful, warm, often involving whole breast tissue</li>\n<li>Peau d'orange appearance</li>\n<li>More than 1/3rd of the skin over the breast is involved; often extends to the skin of the chest wall</li>\n<li>Diffuse lymphoedema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ductal or lobular <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> type with cancer cells in <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> lymphatics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirmation Tests</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC (Fine Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> Cytology)</li>\n<li>Punch <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is ideal and better</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>External <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> and chemotherapy</li>\n<li>Salvage surgery whenever possible</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differential Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"f9bb7eef89169277719156e408105a\">mastitis</span> (total count is increased in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"f9bb7eef89169277719156e408105a\">mastitis</span> and normal in <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> breast cancer)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/q1Fj4G5O6f9Z2NDBC13T1744868851.mp3", "video": ""}, {"text": "A 45-year-old woman with a family history of breast cancer undergoes genetic testing and is found to have a BRCA1 mutation. What are the implications of this mutation regarding her cancer risks and potential associated cancers?", "options": [{"label": "A", "text": "Increased risk of breast cancer with well-differentiated hormone receptor-positive tumors.", "correct": false}, {"label": "B", "text": "Increased risk of breast cancer, typically high-grade and triple-negative, along with higher risks of colon and prostate cancers.", "correct": true}, {"label": "C", "text": "Increased risk of breast cancer and higher risk of endometrial cancer.", "correct": false}, {"label": "D", "text": "Increased risk of ovarian cancer with no significant increase in breast cancer risk.", "correct": false}], "correct_answer": "B. Increased risk of breast cancer, typically high-grade and triple-negative, along with higher risks of colon and prostate cancers.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>BRCA1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>BRCA2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General Population: Rare (1 in 1000)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General Population: Rare (1 in 1000)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosome Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chromosome <strong>17q21</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chromosome <strong>13q12</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Autosomal dominant</strong>: 50% chance of <span class=\"customMeta\" data-dictid=\"3b632faa131692777190ac40c2f1ea\">inheritance</span> from an affected parent</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Autosomal dominant</strong>: 50% chance of <span class=\"customMeta\" data-dictid=\"3b632faa131692777190ac40c2f1ea\">inheritance</span> from an affected parent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer Risks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breast Cancer: 60-70% lifetime risk, up to 85% in some families</li>\n<li><strong>Male Breast Cancer: Not increased</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breast Cancer: Slightly lower risk, nearing 85% <strong>Male Breast Cancer: Increased risk (6%)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ovarian Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Up to 40% lifetime risk</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>20-30% lifetime risk</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast Cancer Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High grade, <strong>hormone receptor-negative</strong></li>\n<li><strong>Often triple-negative </strong>(ER-negative, PR-negative, HER2-negative)</li>\n<li>Basal phenotype</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically<strong> <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> ductal carcinomas</strong></li>\n<li>More likely <strong>hormone receptor-positive</strong> <strong>(Option A)</strong></li>\n<li>Well-differentiated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased risk of <strong>colon and <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> cancers</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Broader spectrum: <strong>prostate, colon, pancreatic, gallbladder, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, stomach cancers and melanoma</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Penetrance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inheriting a <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> does not guarantee cancer but significantly increases risk</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inheriting a <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> does not guarantee cancer but significantly increases risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WLgDprQ80U1gtzG0sWI61744871717.mp3", "video": ""}, {"text": "A 35-year-old woman presents with cyclical breast pain and palpable lumps in her breasts. She reports that the pain increases just before her menstrual period. Physical examination reveals dense breast tissue without any nipple discharge or skin involvement. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Mucinous carcinoma", "correct": false}, {"label": "B", "text": "Fibrocystic Changes", "correct": true}, {"label": "C", "text": "Medullary Carcinoma", "correct": false}, {"label": "D", "text": "Ductal carcinoma", "correct": false}], "correct_answer": "B. Fibrocystic Changes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:565px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fibrocystic changes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrocystic disease is outdated</li>\n<li>Current term: <span class=\"customMeta\" data-dictid=\"324b16a1871692777202ffd73f169b\">Fibrocystic</span> changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Believed to result from an exaggerated response to <strong>hormonal fluctuations</strong>, particularly estrogen.</li>\n<li>Involves <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and altered <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> rather than hyperplasia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common: Breast pain <strong>(mastalgia)</strong>, either <strong>cyclical</strong><strong> </strong>(linked to <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle) or <strong>non cyclical</strong>.</li>\n<li>Breast may feel<strong> </strong><strong>lumpy or dense</strong>.</li>\n<li><strong>Palpable cysts</strong> may develop.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patient history: Age, <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> history, previous breast biopsies.</li>\n<li>Physical examination: Visual inspection, <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of breast tissue and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Imaging tests:\n\t\t\t\t<ul>\n<li><strong>Mammography</strong>: Detects dense tissue or cysts.</li>\n<li><strong>Ultrasound</strong>: Differentiates cysts from solid masses.</li>\n</ul>\n</li>\n<li>Biopsy: To rule out <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> or evaluate suspicious findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>No treatment is needed for mild symptoms.</strong></li>\n<li>Symptomatic relief</li>\n<li><strong>Cyst aspiration</strong>: Draining fluid from large or painful cysts.</li>\n<li><strong>Hormonal therapy</strong>: Medications like danocrine, lupron, or tamoxifen in some cases (not typically first-line treatment due to potential side effects).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Special Considerations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normally benign</li>\n<li>Some <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> findings within <span class=\"customMeta\" data-dictid=\"324b16a1871692777202ffd73f169b\">fibrocystic</span> changes, such as <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> ductal <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (ADH), increase the future risk of breast cancer.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rBA8y3mNslQa2saXSlbG1744871546.mp3", "video": ""}, {"text": "A 35-year-old woman presents with a tender, thrombosed subcutaneous cord on her right breast, which becomes more pronounced when she raises her arm. She reports no recent trauma or infections. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ductal carcinoma in situ", "correct": false}, {"label": "B", "text": "Mondor's Disease", "correct": true}, {"label": "C", "text": "Mastitis", "correct": false}, {"label": "D", "text": "Fibrocystic Changes", "correct": false}], "correct_answer": "B. Mondor's Disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NMPcY7h5UPyLkxDwsW2g1739870034.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mondor’s disease </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n\t\t\t </td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thrombophlebitis </strong>of <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins in the breast and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chest wall.</li>\n<li><strong>Benign</strong>, self-limiting condition, not indicative of cancer.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unknown; can be due to injury or infection.</li>\n<li>Affected Veins: <strong>Lateral thoracic, thoracoepigastric, and <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> epigastric veins.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tender, <span class=\"customMeta\" data-dictid=\"d32945833c16927772005b5e05a44f\">thrombosed</span> <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> cord attached to the skin (<strong>string</strong> <strong>phlebitis</strong>)</li>\n<li>Narrow, shallow <strong>subcutaneous groove</strong> appears on arm Raise</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Limit arm movement</strong></li>\n<li>Anti-inflammatory medications</li>\n<li>Warm compresses</li>\n<li>Biopsy- if diagnosis is uncertain or a mass is present near the cord.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms usually <strong>resolve in 4 to 6 weeks</strong> without <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ocjrv18rCWEMb9UWqdbr1744871095.mp3", "video": ""}, {"text": "A 20-year-old woman presents with a painless, firm, mobile lump in her breast. On physical examination, the lump is approximately 1 cm in diameter, firm, well-circumscribed, and freely mobile. Ultrasound confirms a well-defined, solid, homogeneous mass with smooth margins and no signs of calcifications. What is the most likely diagnosis and management plan?", "options": [{"label": "A", "text": "Cyst; surgical excision.", "correct": false}, {"label": "B", "text": "Fibroadenoma; conservative management with regular monitoring.", "correct": true}, {"label": "C", "text": "Giant fibroadenoma; immediate surgical removal.", "correct": false}, {"label": "D", "text": "Inflammatory carcinoma; urgent biopsy and treatment.", "correct": false}], "correct_answer": "B. Fibroadenoma; conservative management with regular monitoring.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fibroadenoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign tumors arising from the <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> of <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> tissue in the breast</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common in women aged <strong>15-25 years</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Believed to be influenced by <strong>hormonal fluctuations</strong><strong> </strong>during <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless, firm, rubbery, and mobile lumps</li>\n<li>Described as feeling like a<strong> </strong><strong>\"marble in the breast\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Triple Assessment</strong><strong>: </strong>Clinical examination, radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (ultrasound), tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (core-needle biopsy)</li>\n<li>Ultrasound: Helps distinguish fibroadenomas from cysts</li>\n<li>Core-Needle Biopsy: Provides <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative Management: Watchful waiting, regular monitoring</li>\n</ul>\n<p><strong>(Option B)</strong></p>\n<ul>\n<li>Surgical Excision: For larger fibroadenomas, those causing symptoms, or uncertain diagnosis</li>\n<li>Giant Fibroadenomas: Over 5 cm, may require <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> through <span class=\"customMeta\" data-dictid=\"d8c57cf5eb169277719912053c51a1\">submammary</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Benign</strong>, do not increase risk of breast cancer</li>\n<li>Growth can vary, influenced by hormonal changes</li>\n<li>Recurrence is uncommon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relationship to ANDI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Categorised according to ANDI as:\n\t\t\t\t<ul>\n<li><strong>Normal: Small fibroadenomas (≤1 cm)</strong></li>\n<li><strong>Disorder: Larger fibroadenomas (≤3 cm)</strong></li>\n<li><strong>Disease: Giant fibroadenomas (&gt;3 cm), multiple fibroadenomas</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0zDSP68MDylgFAORaVlq1744870398.mp3", "video": ""}, {"text": "Which of the following statements regarding phyllodes tumor are correct? Statements: Tumors of mixed connective tissue and epithelium Classified as benign, intermediate, and malignant Discrete structure with cystic spaces in USG Excisional biopsy is the definitive diagnostic method", "options": [{"label": "A", "text": "1,3", "correct": false}, {"label": "B", "text": "4", "correct": false}, {"label": "C", "text": "3,4", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": true}], "correct_answer": "D. 1,2,3,4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Description</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors of mixed <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue and epithelium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classification</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Benign <span class=\"customMeta\" data-dictid=\"5ea5a8a7d71692777195dd957c9057\">Phyllodes</span> Tumors</strong></li>\n<li><strong>Intermediate (Borderline) <span class=\"customMeta\" data-dictid=\"5ea5a8a7d71692777195dd957c9057\">Phyllodes</span> Tumors</strong></li>\n<li><strong>Malignant <span class=\"customMeta\" data-dictid=\"5ea5a8a7d71692777195dd957c9057\">Phyllodes</span> Tumors</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histological Features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign: Similar to fibroadenomas with whorled <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> and leaf-like structures</li>\n<li>Malignant: <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">Atypical</span> cells, increased cellularity, high mitotic count, and stromal overgrowth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign tumors: Lobulated, firm masses of average size ~5 cm</li>\n<li>Malignant tumors: Rapid growth and larger size; can occur in older patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mammography: Round densities with smooth borders, indistinguishable from fibroadenomas</li>\n<li><strong>Ultrasound: <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">Discrete</span> structure with <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Core needle <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (CNB) preferred</li>\n<li><strong>Excisional <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is definitive</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign: Local excision</li>\n<li>Intermediate: <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> with negative margins (at least 1 cm)</li>\n<li>Malignant: Complete <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> excision; total <span class=\"customMeta\" data-dictid=\"f42d156f7f169277719184a0e26244\">mastectomy</span> if large; possible <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> radiation therapy if margins are concerning</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrence Risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Especially within the first 2 years after excision</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xssaGQcmkGsHEMix7xTc1744870105.mp3", "video": ""}, {"text": "A 55-year-old menopausal woman presents with a unilateral, scaly, and erythematous lesion on her nipple, initially resembling eczema but without itching (image given below). She was diagnosed with Paget’s disease of the nipple. Which of the following cancers is most commonly associated with Paget’s disease?", "options": [{"label": "A", "text": "Invasive ductal carcinoma", "correct": false}, {"label": "B", "text": "Invasive lobular carcinoma", "correct": false}, {"label": "C", "text": "Ductal carcinoma in situ", "correct": true}, {"label": "D", "text": "Lobular carcinoma in situ", "correct": false}], "correct_answer": "C. Ductal carcinoma in situ", "question_images": ["https://image.prepladder.com/content/1R98S2Ps9DbYzozLHItQ1739869972.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nature of Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial manifestation of an <span class=\"customMeta\" data-dictid=\"3c341512011692777190a337e2afc9\">intraductal</span> carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hard <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> just underneath the <span class=\"customMeta\" data-dictid=\"f206b2cc1e1692777182d953d68475\">areola</span> that later ulcerates and causes destruction of the nipple</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains large, ovoid, clear Paget's cells with <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> features</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incidence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2% of breast cancer cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated Carcinoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90% is <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> ductal carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified Radical Mastectomy (MRM)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:553px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Paget's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Eczema of Nipple</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laterality</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Edges</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distinct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indistinct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Itching</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurrence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in menopausal women</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs during the time of lactation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vesicles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nipple Condition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nipple is usually destroyed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nipple is usually intact</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Underlying Lump</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No underlying lump</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tBrfr9xMQI6nMQ20OdFU1744869940.mp3", "video": ""}, {"text": "A 65-year-old man presents with a hard, unilateral breast lump and nipple retraction. Clinical examination reveals skin dimpling and axillary lymphadenopathy. A biopsy confirms breast cancer. Which of the following is wrong about his diagnosis?", "options": [{"label": "A", "text": "Associated with BRCA2 mutation", "correct": false}, {"label": "B", "text": "Most common in 3rd decade of life", "correct": true}, {"label": "C", "text": "Poorer prognosis compared to carcinoma breast in females", "correct": false}, {"label": "D", "text": "Infiltrating duct carcinoma is the most common type", "correct": false}], "correct_answer": "B. Most common in 3rd decade of life", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incidence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 1% of breast cancer cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mean Age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>65 years</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>BRCA2 gene mutation</strong></li>\n<li>Radiation</li>\n<li>Excess estrogen</li>\n<li>Cirrhosis</li>\n<li>Klinefelter's syndrome</li>\n<li>Liver schistosomiasis</li>\n<li>Family history</li>\n<li>Testicular disease</li>\n<li>Infertility</li>\n<li>Obesity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common Type</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infiltrating <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (90%)</strong>, Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (10%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilateral hard breast lump</li>\n<li>Eccentric</li>\n<li>Nipple <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> and discharge</li>\n<li>Skin dimpling</li>\n<li>Axillary lymphadenopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Investigations and Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Same as <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> of the female breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Poorer <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> breast in females</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FoKGykh0nZ6l3E04hxSx1744869704.mp3", "video": ""}, {"text": "A 25-year-old was diagnosed with invasive ductal carcinoma in her 5th week of gestation. Her axillary lymph node biopsy has come back positive. What is the most appropriate management along with modified radical mastectomy?", "options": [{"label": "A", "text": "Termination of pregnancy", "correct": false}, {"label": "B", "text": "Chemotherapy", "correct": false}, {"label": "C", "text": "Radiation therapy", "correct": false}, {"label": "D", "text": "Termination of pregnancy and chemotherapy", "correct": true}], "correct_answer": "D. Termination of pregnancy and chemotherapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1st trimester</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2nd trimester</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3rd trimester</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified radical mastectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified radical mastectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified radical mastectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Termination and <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> if the axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node-positive </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Careful chemotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>After delivery - <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> (lactation is contraindicated)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/P699S42hG7C5TyeeSyc31744869086.mp3", "video": ""}, {"text": "A 45-year-old woman presents with a palpable mass in her left breast. On examination, the mass is 3 cm in diameter, and there is no evidence of skin or chest wall involvement. An ultrasound reveals a single enlarged axillary lymph node. Biopsy confirms invasive ductal carcinoma, ER/PR positive, HER2 negative, shows no distant metastasis. What is the most appropriate management approach?", "options": [{"label": "A", "text": "Total mastectomy with sentinel lymph node biopsy (SLNB)", "correct": false}, {"label": "B", "text": "Breast-conserving surgery (BCS) with SLNB followed by radiotherapy (RT)", "correct": true}, {"label": "C", "text": "Neoadjuvant chemotherapy followed by mastectomy", "correct": false}, {"label": "D", "text": "BCS with axillary lymph node dissection (ALND) without radiotherapy", "correct": false}], "correct_answer": "B. Breast-conserving surgery (BCS) with SLNB followed by radiotherapy (RT)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tFJgZga4m8R2RAI2te1V1744866556.mp3", "video": ""}, {"text": "What is the primary purpose of a sentinel lymph node biopsy in the management of cancer, and how does it help guide treatment decisions?", "options": [{"label": "A", "text": "To determine the exact stage of the cancer by identifying all affected lymph nodes.", "correct": false}, {"label": "B", "text": "To assess whether cancer has spread to the lymph nodes.", "correct": true}, {"label": "C", "text": "To completely remove all lymph nodes to prevent cancer recurrence.", "correct": false}, {"label": "D", "text": "To evaluate the effectiveness of chemotherapy before surgery.", "correct": false}], "correct_answer": "B. To assess whether cancer has spread to the lymph nodes.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/twnm4ZcKcau565fDfeNt1739869864.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Blue <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Radioactive <span class=\"customMeta\" data-dictid=\"887a04d130169277720091d7c1eeea\">tracer</span> technique</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1% Lymphazurin/isosulfan blue is <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> around the tumour.</li>\n<li>It is <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> inside <span class=\"customMeta\" data-dictid=\"f206b2cc1e1692777182d953d68475\">areola</span> around the nipple.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> flows through the <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> system and stains the nodes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Technetium -99m labelled <span class=\"customMeta\" data-dictid=\"2e711a1abe1692777184b0bf50216b\">colloid</span> is used.</li>\n<li>Gamma <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> is used to detect <span class=\"customMeta\" data-dictid=\"4b0e9a90c616927771971e69915a5f\">radioactivity</span> in <span class=\"customMeta\" data-dictid=\"f08132bdfb16927771986a66c5d7b6\">sentinel</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</li>\n<li>Tumor is localised and excised for biopsy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2NW7jzgHn7JZ5RSK9JQV1744868462.mp3", "video": ""}, {"text": "Which of the following components is not evaluated in the Bloom-Richardson grading system?", "options": [{"label": "A", "text": "Tubule formation", "correct": false}, {"label": "B", "text": "Nuclear pleomorphism", "correct": false}, {"label": "C", "text": "Mitotic count", "correct": false}, {"label": "D", "text": "Tumor size", "correct": true}], "correct_answer": "D. Tumor size", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tubule Formation:</strong></p>\n<p>Percentage of the tumor that forms normal <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Score 1</strong>: &gt;75% of tumor area forms tubules</li>\n<li><strong>Score 2</strong>: 10-75% of tumor area forms tubules</li>\n<li><strong>Score 3</strong>: &lt;10% of tumor area forms tubules</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nuclear Pleomorphism:</strong></p>\n<p>Variation in size and shape of the tumor cell nuclei</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Score 1</strong>: Small, uniform nuclei</li>\n<li><strong>Score 2</strong>: Moderate increase in size and variability</li>\n<li><strong>Score 3</strong>: Marked variation in size and shape, large and bizarre nuclei</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitotic Count:</strong></p>\n<p>Number of mitoses per 10 high-power fields</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Score 1</strong>: 0-9 mitoses per 10 high-power fields</li>\n<li><strong>Score 2</strong>: 10-19 mitoses per 10 high-power fields</li>\n<li><strong>Score 3</strong>: 20 or more mitoses per 10 high-power fields</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grades</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1 : Well-differentiated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2 : Moderately differentiated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3 : Poorly differentiated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8-9</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JU5VoJOhXIb3D0gJQ3eT1744868386.mp3", "video": ""}, {"text": "Which of the following statements about the TRAM flap is true?", "options": [{"label": "A", "text": "The TRAM flap uses only skin and fat from the abdomen, preserving the abdominal muscle.", "correct": false}, {"label": "B", "text": "The TRAM flap relies on tissue from the back, including skin and muscle, for reconstruction.", "correct": false}, {"label": "C", "text": "The TRAM flap involves using tissue from the abdomen, including both skin and muscle, for breast reconstruction.", "correct": true}, {"label": "D", "text": "The TRAM flap uses tissue from the thigh, including skin and fat, to reconstruct the breast.", "correct": false}], "correct_answer": "C. The TRAM flap involves using tissue from the abdomen, including both skin and muscle, for breast reconstruction.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TrjfNeESsvaqmmp4c4801739869758.png", "https://image.prepladder.com/content/Vh0SmvW55BE1hab9JD201739869775.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Flaps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Correlation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transverse <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">Rectus</span> Abdominis Muscle <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">Flap</span> (TRAM)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Free <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> involves using tissue from the abdomen, including both skin and muscle</li>\n<li>Most commonly used <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> but not the best flap</li>\n<li>It is based on <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels</li>\n<li>Disadvantage: causes weakness in <span class=\"customMeta\" data-dictid=\"fab77fbe55169277719011d192986d\">infra</span> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> region</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">Perforator</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> (DIEP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Flap which uses skin and fat from lower abdomen, but spares <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> muscles</li>\n<li>Best <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> for breast <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> as there is no risk of <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> and muscle weakness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Latissimus <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">Dorsi</span> Flap</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Flap which uses <span class=\"customMeta\" data-dictid=\"12ad4210e4169277719111f356b7ba\">Latissimus</span> <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">dorsi</span> muscle, skin and fat</li>\n<li>It is a type of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> based on thoracodorsal vessels.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iQ4HyVYr4sGOmhuRga511744867998.mp3", "video": ""}, {"text": "A patient develops a painful, swollen area in the axillary region two weeks after mastectomy. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Seroma", "correct": true}, {"label": "B", "text": "Lymphedema", "correct": false}, {"label": "C", "text": "Hematoma", "correct": false}, {"label": "D", "text": "Axillary lymphadenopathy", "correct": false}], "correct_answer": "A. Seroma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Explanations </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphedema <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Swelling caused by the accumulation of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> fluid in the arm or <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> due to the removal of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.(After MRM and axillary dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wound infection/Flap necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postoperative infections where blackening of <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line is seen (flap necrosis), if necrosed site note removed, leads to wound infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Post-Mastectomy Pain Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic pain in the chest or upper arm due to nerve damage or <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nerve Injuries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long<strong> </strong>thoracic nerve- injury leads to winging of scapula</li>\n<li>Thoracodorsal nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphangiosarcoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Stewart-treves syndrome</strong> - Cancerous growth in the <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels, often associated with long-standing lymphedema.</li>\n<li>After an average of 10.5 years following MRM and radiotherapy, patient develops angiosarcoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/h3PiWBglfXPGuTQqLsJl1744867829.mp3", "video": ""}, {"text": "Match the following hormonal therapy drugs with their primary use: 1.Tamoxifen a. Pre-menopausal hormone receptor-positive breast cancer 2.Anastrozole b. Post-menopausal hormone receptor-positive breast cancer 3.Fulvestrant c. HER2-positive breast cancer 4.Trastuzumab d. Hormone receptor-positive metastatic breast cancer", "options": [{"label": "A", "text": "1-a, 2-b, 3-d, 4-c", "correct": true}, {"label": "B", "text": "1-b, 2-c, 3-d, 4-a", "correct": false}, {"label": "C", "text": "1-a, 2,d, 3-b, 4-c", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-b, 4-d", "correct": false}], "correct_answer": "A. 1-a, 2-b, 3-d, 4-c", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Given for</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Correlation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tamoxifen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pre-menopausal hormone receptor-positive breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Selective <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"a4dd3586e816927771927d01e3fe29\">modulator</span> (SERM)</strong><strong> </strong>works by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors on breast cancer cells, which can slow or stop the growth of tumors that require <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> to grow.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anastrozole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Post-menopausal hormone receptor-positive breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aromatase inhibitors</strong> that reduce the production of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> in the body by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> aromatase, which converts androgens into <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> in <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fulvestrant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormone receptor-positive metastatic breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists </strong>work by binding to <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors and degrading them, which helps to reduce the growth of estrogen-dependent cancer cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trastuzumab</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HER2-positive breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monoclonal antibodies</strong><strong> </strong>that target the HER2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> the growth of cancer cells and can also recruit the body's immune system to destroy these cells.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lYjmgIOeATXwsZRGPecR1744867671.mp3", "video": ""}, {"text": "Which of the following types of breast carcinoma is most likely to respond best to radiation therapy?", "options": [{"label": "A", "text": "Invasive ductal carcinoma", "correct": false}, {"label": "B", "text": "Inflammatory breast cancer", "correct": false}, {"label": "C", "text": "Ductal carcinoma in situ (DCIS)", "correct": true}, {"label": "D", "text": "Triple-negative breast cancer", "correct": false}], "correct_answer": "C. Ductal carcinoma in situ (DCIS)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0ZNjaQdJPX9Y1VHBcFvp1744867529.mp3", "video": ""}, {"text": "A 55-year-old woman with Stage IV HER2-positive metastatic breast cancer presents with fungation of the breast, multiple metastases to the liver and bones. Which of the following treatment strategies is most appropriate for her condition?", "options": [{"label": "A", "text": "Trastuzumab + Chemotherapy + Palliative mastectomy", "correct": true}, {"label": "B", "text": "Tamoxifen + Radiation Therapy + Bone-targeted therapy", "correct": false}, {"label": "C", "text": "Hormonal Therapy alone", "correct": false}, {"label": "D", "text": "Surgical Resection of Metastases + Radiotherapy", "correct": false}], "correct_answer": "A. Trastuzumab + Chemotherapy + Palliative mastectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Targeted Therapy:</strong> Specific for HER2-positive cancers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trastuzumab, Pertuzumab, Lapatinib</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapy:</strong> Addresses <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Taxanes, Anthracyclines, Capecitabine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormonal Therapy: </strong>For hormone receptor-positive cases (not standalone for HER2-positive)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tamoxifen, <span class=\"customMeta\" data-dictid=\"b249ba1c6a16927771821b83b1fd9b\">Aromatase</span> Inhibitors (if combined)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palliative Surgery: </strong>Relieves significant symptoms from primary tumor growth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mastectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy:</strong> Controls <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> symptoms, especially bone metastases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>_</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone-targeted Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Manages bone <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> and reduces skeletal-related events</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bisphosphonates, Denosumab</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vDZ5Zy55FIXpRaxCUzjc1744867038.mp3", "video": ""}, {"text": "A 52-year-old woman presents with Stage III B breast cancer. Her diagnostic workup includes imaging studies and biopsy, revealing a locally advanced tumor with involvement of regional lymph nodes. The tumor is hormone receptor-positive and HER2-positive. What would be the most appropriate management approach for this patient?", "options": [{"label": "A", "text": "Neoadjuvant chemotherapy followed by modified radical mastectomy and adjuvant radiotherapy", "correct": true}, {"label": "B", "text": "Immediate modified radical mastectomy followed by adjuvant chemotherapy and endocrine therapy", "correct": false}, {"label": "C", "text": "Primary endocrine therapy followed by adjuvant chemotherapy and radiotherapy", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy followed by lumpectomy and adjuvant radiotherapy", "correct": false}], "correct_answer": "A. Neoadjuvant chemotherapy followed by modified radical mastectomy and adjuvant radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Y4GfXwPAY4ymwwnv0mc01744866768.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old woman presents with a large adrenal mass discovered incidentally on imaging. The tumor measures 12 cm and shows irregular borders with central necrosis. She exhibits symptoms of Cushing syndrome. What is the most likely diagnosis for this adrenal mass?", "options": [{"label": "A", "text": "Benign Cortical Adenoma", "correct": false}, {"label": "B", "text": "Adrenal Myelolipoma", "correct": false}, {"label": "C", "text": "Adrenocortical Carcinoma", "correct": true}, {"label": "D", "text": "Aldosterone-Producing Adenoma", "correct": false}], "correct_answer": "C. Adrenocortical Carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/it61OYNAPbjw30YZQNta1738683818.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc resection</strong> of adjacent organs or regional lymphadenectomy.</p>\n<p>Right-sided tumors &gt;9 cm may extend into <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> or heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drugs given to control <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hypersecretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>K: Ketoconazole</p>\n<p>A: Aminoglutethimide</p>\n<p>M: Metyrapone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mitotane is used as <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> therapy or for unresectable/metastatic disease but has significant GI and neurologic toxicity.</li>\n<li>FIRM-ACT Trial showed that etoposide, doxorubicin, cisplatin, and <span class=\"customMeta\" data-dictid=\"68bd0e56e216927771929b66676e7d\">mitotane</span> improved response rates and progression-free survival.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MwW4EvxsXsWizpouOa2c1748156866.mp3", "video": ""}, {"text": "Which of the following is not an indication for surgery in an asymptomatic patient with primary hyperparathyroidism?", "options": [{"label": "A", "text": "Serum calcium level 0.25 mmol/L above the upper limit of normal", "correct": false}, {"label": "B", "text": "DEXA T score of -2.5 at the lumbar spine", "correct": false}, {"label": "C", "text": "Creatinine clearance &amp;lt;60 mL/min", "correct": false}, {"label": "D", "text": "Age &amp;gt;60 years", "correct": true}], "correct_answer": "D. Age &gt;60 years", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Dsn9JID1MxAJl1cbw3A21748157945.mp3", "video": ""}, {"text": "Which of the following statements is TRUE regarding olfactory neuroblastoma?", "options": [{"label": "A", "text": "Benign tumor arising from the squamous epithelium of the nasal cavity.", "correct": false}, {"label": "B", "text": "Presents as a bilateral mass in the lower nasal cavity.", "correct": false}, {"label": "C", "text": "Causes anosmia and nasal obstruction due to a unilateral polypoidal mass.", "correct": true}, {"label": "D", "text": "Treated with chemotherapy alone, with no surgical excision.", "correct": false}], "correct_answer": "C. Causes anosmia and nasal obstruction due to a unilateral polypoidal mass.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tfqJEKMhvYtA9XeQoLB11748158177.mp3", "video": ""}, {"text": "A mother brought her 2-year-old child as she noticed he is unable to completely open his eyes and that there is a limp in his walk. On examination, there is a mass in the abdomen and miosis and anhidrosis in the eyes. A biopsy confirms neuroblastoma. What would be the laboratory findings in this case?", "options": [{"label": "A", "text": "Raised 24 hr urinary catecholamines", "correct": true}, {"label": "B", "text": "Low serum LDH", "correct": false}, {"label": "C", "text": "Low neuron specific enolase", "correct": false}, {"label": "D", "text": "Thrombocytopenia", "correct": false}], "correct_answer": "A. Raised 24 hr urinary catecholamines", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KRu1mI36hh0HxXsqiT831748158432.mp3", "video": ""}, {"text": "A child of 2 years is brought to the hospital with an abdominal mass that has grown from the right to the center of the abdomen for a few months. The child has urinary symptoms and bluish-purple discoloration around the eyes. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Pheochromocytoma", "correct": false}, {"label": "B", "text": "Adrenocortical carcinoma", "correct": false}, {"label": "C", "text": "Paraganglioma", "correct": false}, {"label": "D", "text": "Neuroblastoma", "correct": true}], "correct_answer": "D. Neuroblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PQve0rPzO2q5cWhKvV0j1738689966.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Neuroblastoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Wilms Tumor (Nephroblastoma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Age of Onset</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Typically diagnosed in children &lt; 5 years (median age 22 months).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Peak <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> between 2 and 5 years (95% by age 10).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Arises in the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> glands (abdominal, retroperitoneal).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Arises in the kidneys (unilateral or bilateral).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Bilateral Occurrence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Bilateral in about 10% of cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Bilateral in 5-10% of cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Associated Syndromes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Commonly associated with Beckwith-Wiedemann syndrome, <span class=\"customMeta\" data-dictid=\"6518acf261169277719312127935af\">Neurofibromatosis</span> type 1, <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">Familial</span> Neuroblastoma.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Associated with WAGR syndrome, Denys-Drash syndrome, Beckwith-Wiedemann syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Genetics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>MYCN amplification, 1p and 11q deletions, ALK mutations.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>WT1 mutations (WAGR, Denys-Drash), IGF2 overexpression (BWS).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Histology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Small round blue cells, rosettes, neuroblasts.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Triphasic pattern: blastemal, epithelial, and stromal components.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Common <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> Sites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Lymph nodes, bones, liver, skin, and lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Lungs (pulmonary metastasis), liver, bones, and brain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Abdominal mass, pain, fever, weight loss, bone pain, <span class=\"customMeta\" data-dictid=\"42825d622516927771943152da2670\">paraneoplastic</span> symptoms (e.g., <span class=\"customMeta\" data-dictid=\"5f3d7c2c011692777194a1b4f713c0\">opsoclonus-myoclonus</span> syndrome).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Abdominal mass, hematuria, hypertension, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, intestinal obstruction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vi8QPaKauxy60w8xPB2d1748158302.mp3", "video": ""}, {"text": "A 55-year-old patient is diagnosed with malignant pheochromocytoma after presenting with persistent hypertension and elevated plasma metanephrines. Imaging reveals metastasis to various sites. Which of the following is not a common site for metastasis?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Brain", "correct": true}, {"label": "C", "text": "Lungs", "correct": false}, {"label": "D", "text": "Kidney", "correct": false}], "correct_answer": "B. Brain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Pheochromocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumors that have undergone <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> to Lymph-node (or) Distant site (<strong>Biochemically same</strong> as Pheochromocytoma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Survival Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-year survival ranges from 20% to 45%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criteria of Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignancy is defined by the development of metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites of Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axial skeleton, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes,<strong> liver, lung, </strong>and <strong>kidney.</strong><strong> </strong><strong>(Option A,C,D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>MIBG &amp; <span class=\"customMeta\" data-dictid=\"e2b22d522e1692777188ced1ea76e3\">Gallium</span> Dotate</strong> is Best for Diagnosis</li>\n<li>Biopsy &amp; FNAC are avoided in <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> Pheochromocytoma</li>\n<li>Confirmed by the <strong>presence of <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> in locations where neuroectodermal tissues are not normally found.</strong></li>\n<li>This is the primary <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> distinguishing <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> pheochromocytomas from <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> ones, as histopathologic features alone are not reliable in predicting malignancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathologic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No histopathologic criteria can accurately predict the clinical course of malignancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical resection, even if not curative, can offer significant <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> benefits by managing mass effects and reducing <span class=\"customMeta\" data-dictid=\"69ccfc60d016927771837a12cdddb2\">catecholamine</span> excess.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response to Radiotherapy/Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal response to <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> and chemotherapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dt1OxjZPsG7ichN71VwA1745397815.mp3", "video": ""}, {"text": "A 30-year-old woman in her 24th week of pregnancy presents with severe headaches, palpitations, and paroxysmal hypertension. Laboratory investigations reveal elevated plasma metanephrines, and imaging confirms the presence of a pheochromocytoma. Which of the following is the most appropriate management strategy for this patient?", "options": [{"label": "A", "text": "Use phenoxybenzamine and plan laparoscopic adrenalectomy in the second trimester.", "correct": true}, {"label": "B", "text": "Wait until the third trimester, use Labetalol to control BP, and perform a C-section followed by adrenalectomy.", "correct": false}, {"label": "C", "text": "Use calcium channel blockers and plan for surgical resection postpartum.", "correct": false}, {"label": "D", "text": "Perform immediate open adrenalectomy.", "correct": false}], "correct_answer": "A. Use phenoxybenzamine and plan laparoscopic adrenalectomy in the second trimester.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identify <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> using biochemical tests and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for localization.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preoperative Preparation</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Start with an <strong>α-adrenoceptor</strong> <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> like phenoxybenzamine.</li>\n<li>Adjust the dose to 100-160 mg/day to achieve postural hypotension.</li>\n<li><strong>Add β-blockers if necessary after α-blockade</strong> to manage tachycardia.</li>\n<li>Other regimens include α-blockade<strong> </strong>with doxazosin or prazosin, with and without β-blockers, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers alone, and using <span class=\"customMeta\" data-dictid=\"69ccfc60d016927771837a12cdddb2\">catecholamine</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> <span class=\"customMeta\" data-dictid=\"d9ffbe8ca9169277719202c5c886c1\">metyrosine</span> in <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Laparoscopic Adrenalectomy</strong>: Preferred for <span class=\"customMeta\" data-dictid=\"7ceec0cc8e16927771949e935d2576\">PCC</span> unless tumor &gt;10 cm or <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> signs are present.</li>\n<li><strong>Open Surgery</strong>: Recommended for large tumors or those along the <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> chain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postoperative Care</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monitor for <span class=\"customMeta\" data-dictid=\"b93b1c964f16927771894edc409f80\">hypovolemia</span> and <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> for 24 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> post-surgery.</li>\n<li>Conduct annual biochemical tests for recurrence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Pheochromocytoma</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Perform <strong>surgical excision</strong>, possibly with <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> for <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> tumors.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> therapies like <span class=\"customMeta\" data-dictid=\"7cd1a840a2169277719756692d362d\">radiolabeled</span> <span class=\"customMeta\" data-dictid=\"4f381b96c616927771929d07ae9e36\">MIBG</span> and octreotide.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma in Pregnancy</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First/Second Trimester</strong>: Implement α-blockade, then proceed with <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> adrenalectomy.</li>\n<li><strong>Third Trimester</strong>: Plan for an <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> C-section followed by <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> 6 weeks later.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/u0IsTtvnAZwxNZ2RnxSR1748157728.mp3", "video": ""}, {"text": "A 33-year-old man presents with a history of paroxysmal hypertension, palpitations, headaches, and sweating. Initial plasma-free metanephrine testing returns positive results. What is the most appropriate next step in the investigation of this patient's condition to confirm the diagnosis?", "options": [{"label": "A", "text": "Performing an MIBG (metaiodobenzylguanidine) scan", "correct": false}, {"label": "B", "text": "Performing a 24-hour urine collection for metanephrines", "correct": true}, {"label": "C", "text": "Conducting a clonidine suppression test", "correct": false}, {"label": "D", "text": "Ordering a CT/MRI scan of the abdomen", "correct": false}], "correct_answer": "B. Performing a 24-hour urine collection for metanephrines", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gna6b3msIWgX1HgXSCZM1739888083.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bnhfnTcxRa18KPcL6ftk1748157573.mp3", "video": ""}, {"text": "A 35-year-old woman presents with episodes of severe headaches, palpitations, and sweating. Imaging reveals a large adrenal mass and biochemical tests confirm elevated plasma metanephrines. Further genetic testing shows a mutation in the SDHB gene. Which of the following genetic syndromes is most likely associated with her condition?", "options": [{"label": "A", "text": "MEN 2 Syndrome", "correct": false}, {"label": "B", "text": "Hereditary Paraganglioma-Pheochromocytoma Syndrome (HPPS)", "correct": true}, {"label": "C", "text": "Von Hippel–Lindau Disease (VHL)", "correct": false}, {"label": "D", "text": "Neurofibromatosis Type 1 (NF1)", "correct": false}], "correct_answer": "B. Hereditary Paraganglioma-Pheochromocytoma Syndrome (HPPS)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndrome/Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Penetrance of PCC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2 Syndrome</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma, hyperparathyroidism, pheochromocytomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>40%–50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary Paraganglioma-Pheochromocytoma Syndromes (HPPS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pheochromocytomas, paragangliomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable (depends on specific gene mutations)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Von Hippel–Lindau Disease (VHL)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CNS and <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemangiomas, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cysts, clear cell <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma, pancreatic <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumors, pheochromocytomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10%–20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurofibromatosis <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> (NF1)</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Café-au-lait spots, axillary freckling, neurofibromas, Lisch nodules, <span class=\"customMeta\" data-dictid=\"83ceeee3151692777194ec61af5c55\">osseous</span> lesions, <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> glioma, pheochromocytomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kaOlzXPeom3DX7ydcgzs1748157434.mp3", "video": ""}, {"text": "A 52-year-old patient presents with intermittent episodes of hypertension, headache, and sweating. After conducting a series of tests, the diagnosis points toward an extra-adrenal pheochromocytoma. What is the most common site for an extra-adrenal pheochromocytoma?", "options": [{"label": "A", "text": "Adrenal medulla", "correct": false}, {"label": "B", "text": "Organ of Zuckerkandl", "correct": true}, {"label": "C", "text": "Parotid gland", "correct": false}, {"label": "D", "text": "Pancreas", "correct": false}], "correct_answer": "B. Organ of Zuckerkandl", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2Lhx4zIjl8byKFm2Sp0I1738687658.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IfVSv5bUo4Bx6B0RCO2Q1748157274.mp3", "video": ""}, {"text": "A 48-year-old man presents with episodic symptoms of severe headache, palpitations, and profuse sweating. His laboratory tests reveal elevated plasma metanephrines, and a CT scan identifies a vascular adrenal mass. Which of the following statements accurately describes the nature of this adrenal mass?", "options": [{"label": "A", "text": "Primarily secretes ACTH, causing continuous hypertension.", "correct": false}, {"label": "B", "text": "It intermittently releases catecholamines, leading to episodes of headache, palpitations, and sweating.", "correct": true}, {"label": "C", "text": "Presents with chronic, steady symptoms without significant paroxysms.", "correct": false}, {"label": "D", "text": "Usually non-vascular and causes minimal clinical symptoms.", "correct": false}], "correct_answer": "B. It intermittently releases catecholamines, leading to episodes of headache, palpitations, and sweating.", "question_images": [], "explanation_images": [], "explanation": "<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Adrenoceptor Activation: Beta-1 Receptors: Stimulate adenylate cyclase, increasing cAMP (cyclic adenosine monophosphate), which enhances cardiac contractility and conduction. Ryanodine-2 Receptors: Increase calcium release, boosting cardiac contractility. Beta-2 Receptors: Cause vasodilation in peripheral blood vessels. Alpha-1 Receptors: Induce vasoconstriction and hypertension. Alpha-2 Receptors: Inhibit norepinephrine release from nerve terminals. Option A: Pheochromocytomas primarily secrete catecholamines (adrenaline and noradrenaline), not ACTH . The symptoms result from intermittent spikes in catecholamine levels rather than continuous secretion. Option C: Pheochromocytomas are known for causing episodic symptoms rather than chronic, steady symptoms. Option D: Pheochromocytomas are highly vascular and are associated with significant clinical symptoms due to the excessive production of catecholamines. Learning Objective: Pheochromocytomas cause episodic headaches, palpitations, and sweating due to the intermittent release of catecholamines, primarily epinephrine and norepinephrine. Extra-adrenal pheochromocytomas (paragangliomas) secrete norepinephrine, not epinephrine, due to the lack of the enzyme Phenylethanolamine N-methyltransferase . (Induced by Cortisol) [Interdependence of Adrenal cortex and Medullla]</li><li>➤ Adrenoceptor Activation:</li><li>➤ Beta-1 Receptors: Stimulate adenylate cyclase, increasing cAMP (cyclic adenosine monophosphate), which enhances cardiac contractility and conduction. Ryanodine-2 Receptors: Increase calcium release, boosting cardiac contractility. Beta-2 Receptors: Cause vasodilation in peripheral blood vessels. Alpha-1 Receptors: Induce vasoconstriction and hypertension. Alpha-2 Receptors: Inhibit norepinephrine release from nerve terminals. Option A: Pheochromocytomas primarily secrete catecholamines (adrenaline and noradrenaline), not ACTH . The symptoms result from intermittent spikes in catecholamine levels rather than continuous secretion. Option C: Pheochromocytomas are known for causing episodic symptoms rather than chronic, steady symptoms. Option D: Pheochromocytomas are highly vascular and are associated with significant clinical symptoms due to the excessive production of catecholamines. Learning Objective: Pheochromocytomas cause episodic headaches, palpitations, and sweating due to the intermittent release of catecholamines, primarily epinephrine and norepinephrine. Extra-adrenal pheochromocytomas (paragangliomas) secrete norepinephrine, not epinephrine, due to the lack of the enzyme Phenylethanolamine N-methyltransferase . (Induced by Cortisol) [Interdependence of Adrenal cortex and Medullla]</li><li>➤ Beta-1 Receptors: Stimulate adenylate cyclase, increasing cAMP (cyclic adenosine monophosphate), which enhances cardiac contractility and conduction.</li><li>➤ Beta-1 Receptors:</li><li>➤ Ryanodine-2 Receptors: Increase calcium release, boosting cardiac contractility.</li><li>➤ Ryanodine-2 Receptors:</li><li>➤ Beta-2 Receptors: Cause vasodilation in peripheral blood vessels.</li><li>➤ Beta-2 Receptors:</li><li>➤ Alpha-1 Receptors: Induce vasoconstriction and hypertension.</li><li>➤ Alpha-1 Receptors:</li><li>➤ Alpha-2 Receptors: Inhibit norepinephrine release from nerve terminals.</li><li>➤ Alpha-2 Receptors:</li><li>➤ Option A: Pheochromocytomas primarily secrete catecholamines (adrenaline and noradrenaline), not ACTH . The symptoms result from intermittent spikes in catecholamine levels rather than continuous secretion. Option C: Pheochromocytomas are known for causing episodic symptoms rather than chronic, steady symptoms. Option D: Pheochromocytomas are highly vascular and are associated with significant clinical symptoms due to the excessive production of catecholamines. Learning Objective:</li><li>➤ Option A: Pheochromocytomas primarily secrete catecholamines (adrenaline and noradrenaline), not ACTH . The symptoms result from intermittent spikes in catecholamine levels rather than continuous secretion.</li><li>➤ Option C: Pheochromocytomas are known for causing episodic symptoms rather than chronic, steady symptoms.</li><li>➤ episodic symptoms</li><li>➤ Option D: Pheochromocytomas are highly vascular and are associated with significant clinical symptoms due to the excessive production of catecholamines.</li><li>➤ Learning Objective:</li><li>➤ Learning Objective:</li><li>➤ Pheochromocytomas cause episodic headaches, palpitations, and sweating due to the intermittent release of catecholamines, primarily epinephrine and norepinephrine.</li><li>➤ Extra-adrenal pheochromocytomas (paragangliomas) secrete norepinephrine, not epinephrine, due to the lack of the enzyme Phenylethanolamine N-methyltransferase .</li><li>➤ Phenylethanolamine N-methyltransferase</li><li>➤ (Induced by Cortisol) [Interdependence of Adrenal cortex and Medullla]</li><li>➤ (Induced by Cortisol) [Interdependence of Adrenal cortex and Medullla]</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PfEzX4AnWtXSzcgUCvPX1748157082.mp3", "video": ""}, {"text": "A 45-year-old patient with h/o chronic kidney disease is found to have elevated serum calcium levels. Which of the following actions of parathyroid hormone (PTH) is most directly responsible for increasing serum calcium levels?", "options": [{"label": "A", "text": "Inhibition of calcium reabsorption in the kidneys.", "correct": false}, {"label": "B", "text": "Stimulation of 1,25-dihydroxyvitamin D production.", "correct": true}, {"label": "C", "text": "Decreased intestinal calcium absorption.", "correct": false}, {"label": "D", "text": "Promotion of bone mineralization.", "correct": false}], "correct_answer": "B. Stimulation of 1,25-dihydroxyvitamin D production.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hJG4Y1G67sBqWkbDnoY91739885259.png", "https://image.prepladder.com/content/Y6WLyYC9UWu9DAvBfmeT1739885346.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">Parathyroid</span> Glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Third pharyngeal pouch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varies, but in 50% of cases found at the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> pole of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">Parathyroid</span> Glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fourth pharyngeal pouch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More constant, typically at the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> aspect of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> near the <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> junction</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lVflHplgB3JltkvgxtPX1748153171.mp3", "video": ""}, {"text": "A 55-year-old woman undergoes a routine abdominal CT scan for an unrelated issue. The scan reveals a 2.5 cm mass in the left adrenal gland. The patient has no history of adrenal disorders but reports occasional episodes of sweating and palpitations. Her blood pressure is elevated. Based on these findings, what condition should be primarily ruled out in the diagnostic workup?", "options": [{"label": "A", "text": "Subclinical Cushing syndrome", "correct": false}, {"label": "B", "text": "Adrenocortical carcinoma", "correct": false}, {"label": "C", "text": "Pheochromocytoma", "correct": true}, {"label": "D", "text": "Aldosteronoma", "correct": false}], "correct_answer": "C. Pheochromocytoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JOaBEokrFzTyKYKhQYn61739886792.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ &gt; 5 cm: Surgery recommended due to &gt;25% malignancy risk.</li><li>↳ 3-5 cm: Strongly consider surgery. Management depends on imaging features, patient age, surgical risk, tumor growth, and patient preference.</li><li>↳ &lt; 3 cm: Observation with follow-up imaging is appropriate.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All patients with <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> incidentalomas should be assessed for <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> based on the size and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> characteristics of the mass.<br/>\n\t\t\tCT differentiates <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> from <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or metastasis.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FNAC</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> differentiates <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> tumors from metastatic tumors.</p>\n<p>Biopsy is avoided in suspected pheochromocytomas due to the risk of crisis.</p>\n<ul>\n<li><strong>FNAC is to be done only after ruling out Pheochromocytoma</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormonal Evaluation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All patients with <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> incidentalomas should be assessed for <span class=\"customMeta\" data-dictid=\"4e02cdf6641692777199b3cc3b7237\">subclinical</span> hormonal hyperfunction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> fractionated metanephrines, catecholamines, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> fractionated metanephrines</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subclinical Cushing Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measure <span class=\"customMeta\" data-dictid=\"2fe6989cf11692777185a228349602\">dehydroepiandrosterone</span> <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> (DHEAS) and perform 1 mg overnight <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> test (DST)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Aldosteronism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measure <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> and <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> activity (if <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> or <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> is present)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XhD8YJJtPVTfhWov27Yn1748156697.mp3", "video": ""}, {"text": "A 50-year-old patient presents with elevated serum calcium levels and a neck mass. After further evaluation, the diagnosis of parathyroid carcinoma is confirmed. The patient is scheduled for surgery. What is the standard surgical treatment for this case to minimize the risk of local recurrence?", "options": [{"label": "A", "text": "Total thyroidectomy", "correct": false}, {"label": "B", "text": "En bloc resection", "correct": true}, {"label": "C", "text": "Lymph node dissection", "correct": false}, {"label": "D", "text": "Total parathyroidectomy", "correct": false}], "correct_answer": "B. En bloc resection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PARATHYROID CARCINOMA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Parathyroid <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> is responsible for 1% of cases of primary hyperparathyroidism.</li>\n<li><strong>Age of onset:</strong> 44 to 54 years</li>\n<li><strong>Serum Calcium:</strong> &gt;14 mg/dL (Mean 14.6 to 15.9 mg/dL)</li>\n<li><strong>Serum PTH:</strong> 5 to 10 fold higher than normal levels.</li>\n<li><strong>Neck Mass:</strong> Present in 34-52% of patients.</li>\n<li>Evidence of <strong>bone disease, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</strong>,<strong> </strong>or <strong>pancreatitis </strong>may be present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Suspicion:</strong> Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium, high PTH, neck mass, or <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> crisis.</li>\n<li><strong>Pathologic Features:</strong> Trabecular pattern, mitotic figures, thick <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> bands, capsular/vessel invasion.</li>\n<li><strong>Definitive Diagnosis:</strong> Local invasion or metastases.</li>\n<li><strong>Immunohistochemistry: </strong>Parafibromin loss (100% specificity), Ki-67, galectin-3, <span class=\"customMeta\" data-dictid=\"3fb8b1d6cf1692777195fc478f1d29\">PGP</span> 9.5.</li>\n<li><strong>Molecular Markers:</strong> Loss of <strong>parafibromin</strong>, <span class=\"customMeta\" data-dictid=\"11cd461a7a16927772019a67021f4c\">upregulation</span> of <strong>PGP 9.5.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">Parathyroid</span> Carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>En-Bloc Resection</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Includes removal of adjacent invaded tissues; performed in 12.5% of cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Resectable <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">Parathyroid</span> Carcinoma</strong> (Local or regional <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> carcinoma)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>En-bloc resection</strong> is standard for initial and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> disease, involving the removal of the tumor along with any invaded structures.</li>\n<li><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection:</strong> Performed only if <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement is confirmed. <strong>(Option C)</strong><br/>\n<strong>CDC73/HRPT2 <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">Variant</span> Carriers:</strong> <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> exploration or selective <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> glands.</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"1ad679c98716927771940c01006ae3\">parathyroidectomy</span> is not favored. <strong>(Option D)</strong><strong> </strong></li>\n<li><strong>Metastasis:</strong> Spreads locally, invading adjacent structures in the neck such as the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles.</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> for palliation of hypercalcemia</li>\n<li><strong>Post-op <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> Monitoring:</strong> Essential for managing \"hungry bone syndrome\".</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Medical Therapy for Unresectable <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">Parathyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> </strong>(When <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> is not <span class=\"customMeta\" data-dictid=\"e93e54afd9169277719731c7b12d94\">resectable</span> due to widespread dissemination)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Managed with <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> control and <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> care.</li>\n<li><strong>Bisphosphonates:</strong> <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">Intravenous</span> <span class=\"customMeta\" data-dictid=\"ad5f81a10a16927772027b5578d506\">zoledronic acid</span> or pamidronate. <strong>Calcimimetics:</strong> Cinacalcet is used if bisphosphonates are ineffective.</li>\n</ul>\n<p>It works on the calcium-sensing <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (CASR) of the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and controls the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> hormone.</p>\n<ul>\n<li><strong>Denosumab:</strong> For hypercalcemia, <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> to bisphosphonates and cinacalcet.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Biotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Emerging therapies include parafibromin inhibitors, <span class=\"customMeta\" data-dictid=\"b5f99c180c16927772008c5dc65414\">telomerase</span> inhibitors, and immune therapies.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IRKJEBbtVs9XguUGi3Db1748156500.mp3", "video": ""}, {"text": "A 45-year-old woman undergoes a total thyroidectomy for the treatment of Graves' disease. Two days postoperatively, she presents with numbness and tingling around her mouth and in her fingers. She also complains of muscle cramps and mild weakness. Laboratory tests reveal decreased serum calcium levels. What is the most likely cause of her symptoms following the surgery?", "options": [{"label": "A", "text": "Postoperative hypophosphatemia", "correct": false}, {"label": "B", "text": "Hypocalcemia due to damage to the parathyroid glands", "correct": true}, {"label": "C", "text": "Infection at the surgical site", "correct": false}, {"label": "D", "text": "Postoperative bleeding leading to hypovolemia", "correct": false}], "correct_answer": "B. Hypocalcemia due to damage to the parathyroid glands", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HYPOPARATHYROIDISM</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thyroid Surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most frequent cause.</p>\n<p>is damage to the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands or their blood supply.<strong> (Option B)</strong></p>\n<p><strong>Risk Factors: </strong></p>\n<ul>\n<li>Bilateral neck exploration,</li>\n<li>Extensive central neck dissection,</li>\n<li>Revision surgery,</li>\n<li>Thyroidectomy for Graves' disease,</li>\n<li>Pediatric patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune Disorders</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoimmune <span class=\"customMeta\" data-dictid=\"df8c884f491692777196c97ae5d3b9\">polyendocrine</span> syndrome type 1</strong> (APS-1).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic Conditions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DiGeorge syndrome</strong>, autosomal dominant hypocalcemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation Therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation to the neck area can damage <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lithium, and some chemotherapeutic agents (Pembrolizumab).</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention:</strong></p>\n<ul>\n<li>Surgical Precautions:</li>\n</ul>\n<ul>\n<li>Careful <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> and preservation of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands.</li>\n<li>Examine <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> specimens for removed <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> tissue.</li>\n<li>Autotransplant confirmed <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> tissue into the <span class=\"customMeta\" data-dictid=\"ebf38dd1b416927771994e550b0d1e\">sternocleidomastoid</span> muscle.</li>\n</ul>\n<ul>\n<li>Calcium and Vit D Supplementation:\n\t\t\t\t<ul>\n<li>Administer <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> (with/without calcitriol) proactively for total <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">thyroidectomy</span> patients.</li>\n<li>Measure <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> or intact <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> levels four hours postoperatively to guide supplementation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management:</strong></p>\n<ul>\n<li>Temporary Hypoparathyroidism: Resolves within 6 months.</li>\n<li>Permanent Hypoparathyroidism: Requires ongoing <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> and/or Vit D replacement.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ogUHszXEjVvyoroLoLwI1748156180.mp3", "video": ""}, {"text": "A 62-year-old woman with a history of tertiary hyperparathyroidism undergoes total parathyroidectomy. Three days later, she presents with carpopedal spasms and numbness around her mouth. Her serum calcium level is 6.9 mg/dL. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pseudohypoparathyroidism", "correct": false}, {"label": "B", "text": "Hungry bone syndrome", "correct": true}, {"label": "C", "text": "Persistent hyperparathyroidism", "correct": false}, {"label": "D", "text": "Recurrent hyperparathyroidism", "correct": false}], "correct_answer": "B. Hungry bone syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BE5eCOZYCLaS4kY5eK1D1748154097.mp3", "video": ""}, {"text": "A 57-year-old patient with chronic renal failure is found to have elevated parathyroid hormone levels, but his serum calcium level is in the normal range. What is the diagnosis?", "options": [{"label": "A", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "B", "text": "Tertiary hyperparathyroidism", "correct": false}, {"label": "C", "text": "Secondary hyperparathyroidism", "correct": true}, {"label": "D", "text": "Calciphylaxis", "correct": false}], "correct_answer": "C. Secondary hyperparathyroidism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physiologic response of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands to hypocalcemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure:\n\t\t\t\t<ul>\n<li><strong>￬ </strong>phosphate excretion</li>\n<li><strong>￪</strong>serum <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> binds to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> &amp; <strong>￬</strong>free <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels.</li>\n<li><strong>￬</strong>1-hydroxylase activity in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> ➜<strong> ￬</strong> 1,25 (OH)2 <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> formation ➜ <strong>￬ </strong>intestinal <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of calcium.</li>\n<li>This results in increased <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> hormone.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Vitamin D deficiency</li>\n<li>Intestinal <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> malabsorption/ steatorrhoea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Phosphate <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> should be reduced, and <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> binders should be used to manage <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> phosphate.</li>\n<li>Vitamin D and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> supplementation.</li>\n<li>Parathyroidectomy should be considered if <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> remains abnormal.</li>\n<li>Patients with Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure: High Calcium, low <span class=\"customMeta\" data-dictid=\"267416c084169277718117fb653ded\">aluminium</span> <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> bath.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tertiary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a condition characterized by persistent autonomous <strong>hypercalcemic</strong> <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> <strong>after a <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplant.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> function, non-suppressible PTH, slow <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> involution, insufficient <span class=\"customMeta\" data-dictid=\"aac0d9195b1692777183ab34253a6b\">calcitriol</span> conversion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium, elevated PTH, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> (at least 1 year post-transplant).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical intervention</strong>: Mainstay of treatment: <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">Subtotal</span> or total <span class=\"customMeta\" data-dictid=\"1ad679c98716927771940c01006ae3\">parathyroidectomy</span> with <span class=\"customMeta\" data-dictid=\"0236d97f401692777182d2ad430f0a\">autotransplantation</span> of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> gland.</p>\n</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Primary hyperparathyroidism</strong></td>\n<td><strong>Secondary hyperparathyroidism</strong></td>\n<td><strong>Tertiary hyperparathyroidism</strong></td>\n</tr>\n<tr>\n<td><strong>PTH</strong></td>\n<td><strong>↑</strong></td>\n<td><strong>↑</strong></td>\n<td><strong>↑↑↑</strong></td>\n</tr>\n<tr>\n<td><strong>Ca2+</strong></td>\n<td><strong>↑*</strong></td>\n<td><strong>↓/N</strong></td>\n<td><strong>↑</strong></td>\n</tr>\n<tr>\n<td><strong>PO4+</strong></td>\n<td><strong>↓</strong></td>\n<td><strong>↑/N</strong></td>\n<td><strong>↑</strong></td>\n</tr>\n<tr>\n<td><strong>Vitamin D</strong></td>\n<td><strong>N/↓</strong></td>\n<td><strong>↓↓↓</strong></td>\n<td><strong>↓/N</strong></td>\n</tr>\n<tr>\n<td><strong>Comments</strong></td>\n<td>\n<p>In 85% a <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> is present</p>\n<p>Important <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">differential</span> diagnosis is FHH</p>\n</td>\n<td>\n<p>Causes include:</p>\n<ul>\n<li>chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>vitamin D deficiency</li>\n</ul>\n</td>\n<td>\n<p>Caused by: </p>\n<ul>\n<li>end stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\">Differential Diagnosis of <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> includes drug <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> (eg: <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> , thiazides) and <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> of malignancy.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gg4YAMiIRbfFo6o08DLc1748153842.mp3", "video": ""}, {"text": "A 40-year-old lady comes to the emergency department with muscle weakness, fatigue, and abdominal pain, and on evaluation, has some memory loss. Her lab reports show elevated serum calcium levels (13mg%), and she is diagnosed with primary hyperparathyroidism. Which of the following is the preferred treatment in this scenario?", "options": [{"label": "A", "text": "Selective estrogen receptor modulators", "correct": false}, {"label": "B", "text": "Bisphosphonates", "correct": false}, {"label": "C", "text": "Parathyroidectomy", "correct": true}, {"label": "D", "text": "Calcimimetic drugs", "correct": false}], "correct_answer": "C. Parathyroidectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cDtLBtE6dS64mPUgmOOI1739885749.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zUCkbRSmssDTyyOjNjum1746104304.mp3", "video": ""}, {"text": "Which of the following is the most accurate investigation to localize the lesion in a case of primary hyperparathyroidism?", "options": [{"label": "A", "text": "Ultrasonography", "correct": false}, {"label": "B", "text": "Sestamibi scan", "correct": true}, {"label": "C", "text": "4D computed tomography", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "B. Sestamibi scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vL8tyLnS21VymEcTbXQh1738681662.png", "https://image.prepladder.com/content/0OgCBey8JPmTlcjq1hwh1738681680.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intact PTH</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low or inappropriately high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum phosphate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> calcium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloride to <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> ratio</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1,25- <span class=\"customMeta\" data-dictid=\"147defe59f16927771894a7addb83d\">hydroxy</span> Vitamin D</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or raised</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sDq0GIbMsALE39N3TJfl1748153673.mp3", "video": ""}, {"text": "A 55-year-old postmenopausal woman presents with a fracture of the radius. She is found to have some mild memory impairment on questioning and her X-ray shows osteoporosis. On further evaluation, her serum calcium levels are elevated. Which of the following is not a common manifestation of this condition?", "options": [{"label": "A", "text": "Nephrolithiasis", "correct": false}, {"label": "B", "text": "Salt and pepper skull", "correct": false}, {"label": "C", "text": "Neck mass", "correct": true}, {"label": "D", "text": "Brown tumors", "correct": false}], "correct_answer": "C. Neck mass", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d9MzZchhZrvZKBguJYnl1738681298.png", "https://image.prepladder.com/content/fnaEgCQTEQUZkHsU0nyW1738681420.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:673px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal system</strong></p>\n<p><strong>(stones) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypercalciuria</li>\n<li>Nephrocalcinosis</li>\n<li>Nephrolithiasis <strong>(Option A) </strong></li>\n<li>Polydipsia, polyuria, nocturia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excretion of <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium</li>\n<li>Calcium deposition in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> parenchyma</li>\n<li>Precipitation of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> with <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> or oxalate</li>\n<li>Inhibition of <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> due to ￪ <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skeletal system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteoporosis</li>\n<li>Subperiosteal resorption(radial aspect)</li>\n<li>Tufting of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> phalanx</li>\n<li>Brown tumor/ <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> fibrosa cystica <strong>(OptionD)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\" Frank Gaillard, Dr Ahmed Haroun\" data-hash=\"\" data-license=\"CC by SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Brown_tumours_of_the_hands.jpg\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/d9MzZchhZrvZKBguJYnl1738681298.png\" width=\"500\"/></p>\n\t\t\t\t \n\n\t\t\t\t<ul>\n<li>Salt and pepper skull <strong>(Option B)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"Gursimran Kaur, Parminder Singh, N. Mittal, M. Singla\" data-hash=\"\" data-license=\"CC by NC SA 3.0\" data-source=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830302/figure/F1/\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/fnaEgCQTEQUZkHsU0nyW1738681420.png\" width=\"657\"/></p>\n\t\t\t\t \n\n\t\t\t\t<ul>\n<li>Chondrocalcinosis</li>\n<li>Pseudo gout</li>\n<li>Joint pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium resorption</li>\n</ul>\n<ul>\n<li>Deposition of <span class=\"customMeta\" data-dictid=\"244b573f9d169277718887b033ba57\">hemosiderin</span> in the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdomen </strong></p>\n<p><strong>(abdominal groans)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Constipation</li>\n<li>Peptic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> groans</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inhibitory effect of <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> on <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> (GI) smooth muscle contraction.</li>\n<li>Spasm of sphincters</li>\n<li>Increased gastrin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CNS</strong></p>\n<p><strong>(psychiatric moans)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confusion</li>\n<li>Anxiety</li>\n<li>Depression</li>\n<li>Psychosis: <span class=\"customMeta\" data-dictid=\"31e024808f169277719632c7d01b89\">psychic</span> moans</li>\n<li>Some mild memory loss</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Depression of nervous system</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscular system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness</li>\n<li>Fatigue overtones</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased muscle activity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rAdXoGI7rtXEqVcd7tf51748153527.mp3", "video": ""}, {"text": "A 45-year-old woman presents with recurrent kidney stones. Lab tests showed elevated calcium and parathyroid hormone levels. Imaging reveals pituitary adenoma and pancreatic neuroendocrine tumors. Her father had similar issues. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Wermer syndrome", "correct": true}, {"label": "B", "text": "Werner syndrome", "correct": false}, {"label": "C", "text": "MEN 4", "correct": false}, {"label": "D", "text": "Sipple syndrome", "correct": false}], "correct_answer": "A. Wermer syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aUk23hlRHDR1RGapCTrX1739885498.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:423px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary hyperparathyroidism(PHPT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>95%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreatic <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> cell tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30 - 80%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pituitary tumors</p>\n<ul>\n<li>Prolactin (60%)</li>\n<li>Growth hormone (25%)</li>\n<li>ACTH (5%)</li>\n<li>Non-functioning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 - 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adrenocortical tumors (mainly non-functioning)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>40 - 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NET lung, thymus, stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 - 10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 -10%</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MEN 1 is also associated with meningiomas and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> angiofibroma</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2A/Sipple Syndrome </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2B/ MEN3</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 4/MEN X</strong><strong> </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutation of <strong>RET gene </strong>located on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 10.</p>\n<p>RET mutations lead to <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> receptors, promoting cancer.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutation of <strong>RET gene </strong>located on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 10.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutation of<strong> CDNK1B</strong> <strong>gene </strong>located on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 12.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves:</p>\n<ol>\n<li><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer</strong></li>\n<li><strong>Pheochromocytoma</strong></li>\n<li><strong>Primary hyperparathyroidism</strong> (PHPT)</li>\n<li>Cutaneous <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> amyloidosis</li>\n<li><strong>Hirschsprung disease</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves :</p>\n<ol>\n<li><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer</strong></li>\n<li><strong>Pheochromocytoma</strong></li>\n<li><strong>Marfanoid habitus</strong></li>\n<li>Ganglioneuromatosis</li>\n<li><strong>Mucosal neuromas</strong></li>\n<li><strong>Hirschsprung disease</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves :</p>\n<ol>\n<li>Parathyroid tumors</li>\n<li>Pituitary tumors</li>\n<li><strong>Renal tumors</strong></li>\n<li><strong>Adrenal tumors</strong></li>\n<li><strong>Gonadal tumors</strong></li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:527px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN Syndrome Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene Mutated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosome Number</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 1/Wermer Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MEN-1 gene</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosome 11</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2A/Sipple Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RET oncogene</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosome 10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2B/MEN 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RET oncogene</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosome 10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 4/MEN X</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CDNK1B gene</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosome 12</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lKQICCzl5goj16AOokYc1748153299.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What would be the appropriate next step in the management of a 55-year-old female patient who has a 4x3 cm lump in the right upper outer quadrant, with no involvement of axillary lymph nodes, and a BIRADS 4b staging on mammography? The patient underwent breast conservation surgery, and the final histopathology examination (HPE) report indicated high nuclear-grade ductal carcinoma in situ (DCIS) with necrosis and a 10mm margin clearance.", "options": [{"label": "A", "text": "Adjuvant radiotherapy", "correct": true}, {"label": "B", "text": "Adjuvant chemotherapy", "correct": false}, {"label": "C", "text": "Follow up 6 monthly for 2 years and then yearly follow up", "correct": false}, {"label": "D", "text": "Trastuzumab therapy", "correct": false}], "correct_answer": "A. Adjuvant radiotherapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\"&gt;Adjuvant&lt;/span&gt; Radioth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following carries the lowest risk of developing invasive ductal carcinoma?", "options": [{"label": "A", "text": "Florid epithelial hyperplasia", "correct": false}, {"label": "B", "text": "Papilloma with fibrovascular core", "correct": false}, {"label": "C", "text": "Atypical hyperplasia", "correct": false}, {"label": "D", "text": "Squamous metaplasia", "correct": true}], "correct_answer": "D. Squamous metaplasia", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p>No increased risk Adenosis, <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> or florid<br/>\n\t\t\t </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Apocrine metaplasia</p>\n</li>\n<li>\n<p> Cysts, macro and/or micro</p>\n</li>\n<li>\n<p> Duct ectasia</p>\n</li>\n<li>\n<p> Fibroadenoma</p>\n</li>\n<li>\n<p> Fibrosis</p>\n</li>\n<li>\n<p> Hyperplasia</p>\n</li>\n<li>\n<p> Mastitis (inflammation)</p>\n</li>\n<li>\n<p> Periductal mastitis</p>\n</li>\n<li>\n<p> Squamous metaplasia </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Slightly increased risk (1.5 – 2 times) </p>\n<p> </p>\n<p>Moderately increased risk (5 times) </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Hyperplasia, moderate or florid, solid or papillary </p>\n</li>\n<li>\n<p>Papilloma with a <span class=\"customMeta\" data-dictid=\"a415391b321692777202ff36543c1c\">fibrovascular</span> core </p>\n</li>\n<li>\n<p>Atypical <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (ductal or lobular)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Insufficient data to assign a risk </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Solitary <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> of <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> sinus </p>\n</li>\n<li>\n<p> Radial <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">Scar</span> lesion </p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old woman who complains of a painless mass in her left breast that can be felt? The mass is highly movable, measures 3 x 3 cm, and has a rubbery texture.", "options": [{"label": "A", "text": "Breast abscess", "correct": false}, {"label": "B", "text": "Phyllodes tumor", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": true}, {"label": "D", "text": "Invasive ductal carcinoma", "correct": false}], "correct_answer": "C. Fibroadenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oqJGUfzISGIt2OjVvTk71685081999.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What preoperative intervention can be administered to minimise intraoperative bleeding in a 32-year-old female patient diagnosed with Grave's disease, presenting with eye symptoms and an enlarged thyroid, who is scheduled to undergo a total thyroidectomy?", "options": [{"label": "A", "text": "Potassium iodide", "correct": true}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "Propylthiouracil", "correct": false}, {"label": "D", "text": "Betamethasone", "correct": false}], "correct_answer": "A. Potassium iodide", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grave’s Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>An <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disorder characterised by the production of <span class=\"customMeta\" data-dictid=\"5af2289f3316927771913669927e2e\">long-acting <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> stimulator</span> (LATS) or<strong> </strong><strong>thyroid-stimulating autoantibodies</strong><strong> </strong><strong>against the <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> receptor, </strong>which results in Hyperthyroidism.</li>\n<li>Increased beta-receptor expression results in <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> (<strong>Tachycardia, Fine tremors, Sweating</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thyrotoxicosis (Symptoms of Hyperthyroidism)</li>\n<li>Ophthalmopathy (Exophthalmos): Accumulation of areolar tissue behind the eye.</li>\n<li>Pretibial Myxedema</li>\n<li>Gynaecomastia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clinical:</strong> Presence of eye signs in <span class=\"customMeta\" data-dictid=\"236b9106d7169277718961e983707b\">hyperthyroid</span> patients.</li>\n<li><strong>Confirmatory Test:</strong> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">Detection</span> of thyroid-stimulating autoantibodies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Stellwag's Sign: </strong>Reduced blink rate or incomplete blinking.</li>\n<li><strong>Dalrymple’s Sign: </strong>Visible upper <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> with lid retraction</li>\n<li><strong>Von Graefe's Sign: </strong>Lid <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> on down gaze</li>\n<li><strong>Joffroy's Sign: </strong>Absence of Forehead wrinkling on Upgaze</li>\n<li><strong>Moebius Sign: </strong>Loss of Accommodation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical management: </strong></p>\n<ul>\n<li><strong>Propranolol</strong> (provide <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief)</li>\n<li>Antithyroid drugs like <span class=\"customMeta\" data-dictid=\"34735bff271692777196f13335f804\">Propylthiouracil</span> <strong>(DOC in 1st trimester)</strong>, Methimazole, and Carbimazole (Can be given in 2n and 3rd trimesters)</li>\n</ul>\n<p><strong>Surgical Intervention: </strong><strong>Total Thyroidectomy</strong> is the treatment of choice, especially when other methods fail or are contraindicated (Lugol’s <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> is used for the pre-operative preparation).</p>\n<ul>\n<li>Adults with <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">Goiter</span> are managed by drugs followed by surgery.</li>\n<li><strong>Radioactive <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">Iodine</span> (RAI) Ablation:</strong>\n<ul>\n<li><strong>Indications:</strong> Elderly patients with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> comorbidities or <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> after surgery.</li>\n<li><strong>Contraindications: </strong>Pregnancy, Lactation, Patient with eye signs (worsens Ophthalmopathy)<strong> </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old female presents with a breast lump. Which of the following findings is in accordance with basal cell type breast cancer?", "options": [{"label": "A", "text": "ER +ve, PR +ve, HER2 -ve", "correct": false}, {"label": "B", "text": "ER +ve, PR -ve, HER2 -ve", "correct": false}, {"label": "C", "text": "ER -ve, PR -ve, HER2 -ve", "correct": true}, {"label": "D", "text": "ER -ve, PR -ve, HER2 +ve", "correct": false}], "correct_answer": "C. ER -ve, PR -ve, HER2 -ve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone receptor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2/Neu</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n<p><strong>(Option A, and B ruled out)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (either or both ER/PR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ki-67 low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal B</strong></p>\n<p><strong>(Option A and B ruled out)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (either or both ER/PR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ki-67 high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal type (triple -ve)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ki-67 usually high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2/neu enriched</strong></p>\n<p><strong>(Option D ruled out)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ki-67 high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Claudin low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Claudin low</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal A (Low <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> rate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tubular carcinoma</li>\n<li>Papillary carcinoma</li>\n<li>Mucinous carcinoma</li>\n<li>Low-grade ILC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal B (High <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> rate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-grade ILC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2/Neu rich</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Apocrine carcinoma.</li>\n<li>Micropapillary carcinoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triple-negative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Medullary carcinoma</li>\n<li>Metaplastic carcinoma.</li>\n<li>Secretory carcinoma.</li>\n<li>Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> carcinoma.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a relative contraindication for breast conservative surgery?", "options": [{"label": "A", "text": "Tumor size &amp;lt;4 cm", "correct": true}, {"label": "B", "text": "Li-Fraumeni Syndrome", "correct": false}, {"label": "C", "text": "Prior radiation to the chest", "correct": false}, {"label": "D", "text": "Genetic Predisposition to Breast Cancer", "correct": false}], "correct_answer": "A. Tumor size &lt;4 cm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:599px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-trimester Pregnancy</li>\n<li>Multicentric Disease</li>\n<li>Diffuse Suspicious microcalcifications on mammogram</li>\n<li>Extensive DCIS</li>\n<li>Inflammatory Breast Cancer</li>\n<li>Tumors for which Clear Margins are Unobtainable with Lumpectomy</li>\n<li>Homozygous for <span class=\"customMeta\" data-dictid=\"17b09d09f81692777182bb007591a1\">ATM</span> Mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prior Radiation Therapy to the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">Chest Wall</span> or Breast <strong>(Option C ruled out)</strong></li>\n<li>Active <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> Tissue Disease Involving the Skin (e.g., Scleroderma)</li>\n<li>Extensive Positive <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">Pathological</span> Margins</li>\n<li>Large Tumor Size Relative to Breast Size or Tumors &gt;5 cm <strong>(Option A)</strong></li>\n<li>Known or Suspected Li-Fraumeni Syndrome (p53 Mutation) <strong>(Option B ruled out)</strong></li>\n<li>Known or Suspected Genetic <span class=\"customMeta\" data-dictid=\"6fc754288b1692777196b7664d3a9a\">Predisposition</span> to Breast Cancer (e.g., BRCA1, BRCA2) <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate next step in managing a 37-year-old unmarried woman who has never given birth, is sexually active, and is currently taking oral contraceptive pills, considering that her mother was diagnosed with breast cancer at the age of 60 and her older sister was diagnosed with ovarian cancer at 40?", "options": [{"label": "A", "text": "Genetic counseling and screening for BRCA", "correct": true}, {"label": "B", "text": "Routine mammography", "correct": false}, {"label": "C", "text": "Stop taking oral and contraceptive pills", "correct": false}, {"label": "D", "text": "Prophylactic surgery", "correct": false}], "correct_answer": "A. Genetic counseling and screening for BRCA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modifiable risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-modifiable risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obesity: <span class=\"customMeta\" data-dictid=\"765e9149d01692777183c3989c6590\">BMI</span> &gt; 30 (RR= 1.29)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n<ul>\n<li>Median age at presentation is 60 years in the West(UK, USA), While it is around 48 years in low/middle-income nations such as India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nulliparous women or first pregnancy after 35 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sex</strong></p>\n<ul>\n<li>Female sex is a risk factor</li>\n<li>Male sex accounts for 0.5-1% of all breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breastfeeding is a protective factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethnicity</strong></p>\n<p><strong>American white, African-American Parsi in India</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use of Hormonal Replacement Therapy (HRT) &gt;10 years (RR= 1.2)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Family history of breast cancer</strong></p>\n<ul>\n<li>1 first-degree relative RR= 2</li>\n<li>2 first-degree relative RR= 3</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tobacco use (RR=1.07-1.14)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic predisposition</strong></p>\n<p>BRCA1 and BRCA2 mutations account for 70% of <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> breast cancers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alcohol Consumption (RR = 1.05-1.32)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Menarche(&lt;12years)</strong></p>\n<p>Increases by around 5% for each year earlier <span class=\"customMeta\" data-dictid=\"af76284ec71692777192c7c84b5dad\">menstruation</span> begins RR=1.19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation exposure (RR=6)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Menopause(&gt;55years)</strong></p>\n<p>Increases by about 3% for each year later <span class=\"customMeta\" data-dictid=\"516cc2e77d169277719213e7926b59\">menopause</span> begins RR=1.12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age at first child</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>&lt;20years - Less risk</li>\n<li>&gt;35years - High risk</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-risk breast lesions</strong></p>\n<ul>\n<li>Complex <span class=\"customMeta\" data-dictid=\"633e6ef4ca169277720219ea037f2c\">fibroadenoma</span> RR=3</li>\n<li>Papillomatosis RR=3</li>\n<li>Ductal and lobular <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> RR= 5</li>\n<li>Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> RR= 8-10</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents with a breast lump, no skin changes, and no indurations. In histology, fibroadenoma appeared. Which of the following categories does it fall under?", "options": [{"label": "A", "text": "BI-RADS 1", "correct": false}, {"label": "B", "text": "BI-RADS 2", "correct": true}, {"label": "C", "text": "BI-RADS 3", "correct": false}, {"label": "D", "text": "BI-RADS 4", "correct": false}], "correct_answer": "B. BI-RADS 2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BI-RADS Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Likelihood of Malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomplete</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Need additional <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> evaluation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Routine screening</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essentially 0%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Routine screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essentially 0%</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Probably Benign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short-term follow-up (6 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 2%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious of Malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsy should be considered.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious: Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>_</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2% to ≤ 10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious: Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>_</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 10% to ≤ 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicious: High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>_</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 50% to ≤ 95%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly Suggestive of Malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appropriate action should be taken</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 95%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Known Biopsy-Proven Malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appropriate action should be taken</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lump in the breast is observed in a female patient. Among the options listed below, all but one can be employed to exclude the presence of cancer. Which one is not applicable for this purpose?", "options": [{"label": "A", "text": "Radiological investigations", "correct": false}, {"label": "B", "text": "PET scan", "correct": true}, {"label": "C", "text": "Clinical examination", "correct": false}, {"label": "D", "text": "Histology and cytology", "correct": false}], "correct_answer": "B. PET scan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Clinical Examination </strong><strong>(Option C ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Objective:</strong> Identify lumps, skin changes, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> discharge, or lymphadenopathy.</p>\n<p><strong>Procedure:</strong> <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">Palpation</span> of breasts and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> </strong><strong>(Option A ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methods: </strong></p>\n<ul>\n<li><strong>Mammography:</strong> Preferred for women over 40.</li>\n<li><strong>Ultrasound:</strong> Used in younger women or for further evaluation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Biopsy</strong></p>\n<p><strong>(Option D ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>FNA:</strong> Minimally invasive; used for <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> lesions.</li>\n<li><strong>Core Needle:</strong> Preferred for solid masses.</li>\n<li><strong>Excisional:</strong> Removes lump for examination.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old lactating mother presents with pain in her left breast and a fever. On examination of the affected side, there is localized erythema, warmth, and point tenderness, the fluctuation test is positive. There is mild axillary lymphadenopathy on the affected side and the contralateral breast is normal. Repeated aspirations under antibiotic cover were unsuccessful. A USG done showed fluid collection. What is the management plan for this patient?", "options": [{"label": "A", "text": "Incision and drainage", "correct": true}, {"label": "B", "text": "Broad spectrum antibiotics only", "correct": false}, {"label": "C", "text": "Breast conservation surgery", "correct": false}, {"label": "D", "text": "Punch biopsy", "correct": false}], "correct_answer": "A. Incision and drainage", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within the breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess: </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes and Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactation: </strong>\n<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li><strong>Non-Lactation: </strong>\n<ul>\n<li>Often in<strong> <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis.</strong></li>\n<li><strong>Smoking and diabetes </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs and symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography: </strong>\n<ul>\n<li>Detects cellulitis, and <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactational Mastitis:</strong>\n<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided is preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision. <strong> </strong><strong>(Option A)</strong></li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews of culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li><strong>Non-Lactational Mastitis:</strong>\n<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old woman presents to the surgery out-patient with a left-sided breast lump, which she noticed on a self-breast examination 3 weeks ago. She has no other complaints. On palpation, the lump seems to be mobile and firm. FNAC is characterized by stromal and epithelial elements with no signs of malignancy. What is the best next step in management?", "options": [{"label": "A", "text": "Mammography", "correct": false}, {"label": "B", "text": "Reassurance and follow-up", "correct": true}, {"label": "C", "text": "Surgical excision", "correct": false}, {"label": "D", "text": "Start Tamoxifen", "correct": false}], "correct_answer": "B. Reassurance and follow-up", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) Reassurance and follow-up</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibroadenoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign tumors arising from the <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> of <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> tissue in the breast</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common in women aged <strong>15-25 years</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Believed to be influenced by <strong>hormonal fluctuations </strong>during <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless, firm, rubbery, and mobile lumps</li>\n<li>Described as feeling like a<strong> \"marble in the breast\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Triple Assessment: </strong>Clinical examination, radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (ultrasound), tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (core-needle biopsy)</li>\n<li>Ultrasound: Helps distinguish fibroadenomas from cysts</li>\n<li>Core-Needle Biopsy: Provides <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative Management: Watchful waiting, regular monitoring</li>\n<li>Surgical Excision: For larger fibroadenomas, those causing symptoms, or uncertain diagnosis</li>\n<li>Giant Fibroadenomas: Over 5 cm, may require <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> through <span class=\"customMeta\" data-dictid=\"d8c57cf5eb169277719912053c51a1\">submammary</span> incision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Benign</strong>, do not increase risk of breast cancer</li>\n<li>Growth can vary, influenced by hormonal changes</li>\n<li>Recurrence is uncommon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relationship to ANDI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Categorised according to ANDI as:\n\t\t\t\t<ul>\n<li><strong>Normal: Small fibroadenomas (≤1 cm)</strong></li>\n<li><strong>Disorder: Larger fibroadenomas (≤3 cm)</strong></li>\n<li><strong>Disease: Giant fibroadenomas (&gt;3 cm), multiple fibroadenomas</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Best prognosis among the following breast cancer subtypes is for:", "options": [{"label": "A", "text": "Luminal A", "correct": true}, {"label": "B", "text": "Luminal B", "correct": false}, {"label": "C", "text": "ER negative", "correct": false}, {"label": "D", "text": "Basal like", "correct": false}], "correct_answer": "A. Luminal A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ER Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PR Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ki-67 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally, it is low grade, has a better prognosis, and is responsive to hormonal therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal B </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher grade, poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A, may require targeted HER2 therapy following status. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2-enriched</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive, higher grade, poor prognosis, requires targeted HER2 therapy.</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal-like</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes triple-negative breast cancer (TNBC), highly aggressive, no targeted hormonal therapy. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Claudin-low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often associated with poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and aggressive behaviour, typically lacks response to hormonal therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old lactating mother presents with pain in her left breast and a fever. On examination of the affected side, there is localised erythema, warmth, and point tenderness, and the fluctuation test is positive. Mild axillary lymphadenopathy is on the affected side, and the contralateral breast is normal. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Lactational mastitis", "correct": false}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Breast abscess", "correct": true}, {"label": "D", "text": "Fibroadenoma", "correct": false}], "correct_answer": "C. Breast abscess", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Breast abscess</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within the breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess: </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes and Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactation:\n\t\t\t\t<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li>Non-Lactation:\n\t\t\t\t<ul>\n<li>Often in<strong> <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis.</strong></li>\n<li><strong>Smoking and diabetes </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Signs and symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ultrasonography:\n\t\t\t\t<ul>\n<li>Detects cellulitis, and <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided is preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision.</li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews, and culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li><strong>Non-Lactational Mastitis:</strong>\n<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old lady presented with a swelling in her neck. She had an exposure to radiation in the past. Identify the type of disease, image of FNAC is given below:", "options": [{"label": "A", "text": "Papillary carcinoma", "correct": true}, {"label": "B", "text": "Follicular carcinoma", "correct": false}, {"label": "C", "text": "Medullary carcinoma", "correct": false}, {"label": "D", "text": "Anaplastic carcinoma", "correct": false}], "correct_answer": "A. Papillary carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\"&gt;Papillary&lt;/span&gt; Carcinoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (80–85%) with excellent prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Childhood radiation exposure, BRAF &amp; RET/PTC mutations, family history.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphatic spread</strong> (cervical <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes commonly affected).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> nodule, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> lymphadenopathy, <span class=\"customMeta\" data-dictid=\"a0cba39e531692777187f51570565d\">euthyroid</span> state.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Orphan Annie eye nuclei, <span class=\"customMeta\" data-dictid=\"af21cbfa5f169277719652e0a79441\">Psammoma</span> bodies, Nuclear grooves, <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> structures with <span class=\"customMeta\" data-dictid=\"a415391b321692777202ff36543c1c\">fibrovascular</span> cores.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <strong>Ultrasound</strong> – Microcalcifications, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> nodule, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> margins. 2. <strong>FNAC</strong> – First-line test.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <strong>Total thyroidectomy</strong> (&gt;1 cm, multifocal, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement). 2. <strong>Lobectomy</strong> (&lt;1 cm, no metastasis). 3. <strong>RAI therapy</strong> (for <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> disease or metastasis). 4. <strong>TSH <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> therapy</strong> (Levothyroxine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Excellent</strong> (&gt;95% 10-year survival). Worse with older age, distant metastasis, large tumor size, BRAF mutation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which patient has better prognosis in breast cancer?", "options": [{"label": "A", "text": "Her2+", "correct": true}, {"label": "B", "text": "Triple negative", "correct": false}, {"label": "C", "text": "Luminal B", "correct": false}, {"label": "D", "text": "Luminal A", "correct": false}], "correct_answer": "A. Her2+", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Receptor Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment Response</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER+, PR+, HER2-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Best prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good response to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy (Tamoxifen, <span class=\"customMeta\" data-dictid=\"b249ba1c6a16927771821b83b1fd9b\">Aromatase</span> inhibitors)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER+, PR±, HER2±</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Responds to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy but has higher <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> than <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HER2+ (non-luminal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER-, PR-, HER2+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poorer prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires <strong>Trastuzumab (Herceptin)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triple-negative (Basal-like)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER-, PR-, HER2-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Worst prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemotherapy is the only option; high recurrence</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the surgical procedure for breast carcinoma, a frozen section was performed. This technique has benefits for all individuals, with the exception of:", "options": [{"label": "A", "text": "To know sentinel lymph node", "correct": false}, {"label": "B", "text": "To know margin positivity", "correct": false}, {"label": "C", "text": "To know metastasis", "correct": false}, {"label": "D", "text": "To confirm definitive diagnosis immediately in all cases", "correct": true}], "correct_answer": "D. To confirm definitive diagnosis immediately in all cases", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient with a history of Hodgkin’s lymphoma and prior radiation therapy presents with a right-sided thyroid swelling. Fine needle aspiration cytology (FNAC) confirms papillary carcinoma with no evidence of lymph node involvement. What is the next step in management?", "options": [{"label": "A", "text": "Hemi-thyroidectomy with modified radical neck dissection", "correct": false}, {"label": "B", "text": "Total thyroidectomy", "correct": true}, {"label": "C", "text": "Total thyroidectomy with modified radical neck dissection", "correct": false}, {"label": "D", "text": "Hemi-thyroidectomy", "correct": false}], "correct_answer": "B. Total thyroidectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fluorescence in-situ hybridization (FISH) is required in which of the following interpretations of HER2/NEU?", "options": [{"label": "A", "text": "1+", "correct": false}, {"label": "B", "text": "2+", "correct": true}, {"label": "C", "text": "3+", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. 2+", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) 2+\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true? 1. Due to increasing mammography there occurs over diagnosis of breast carcinoma 2. Colon cancer screening is done by digital rectal examination 3. Oral cancer screening is done by visual inspection 4. Cervix cancer screening is done by a pap smear", "options": [{"label": "A", "text": "2, 3, 4", "correct": false}, {"label": "B", "text": "1, 2, 3, 4", "correct": false}, {"label": "C", "text": "4 only", "correct": false}, {"label": "D", "text": "1, 3, 4", "correct": true}], "correct_answer": "D. 1, 3, 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) 1, 3, 4</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Statement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>True/False</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Due to increasing mammography, there occurs overdiagnosis of breast carcinoma.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Widespread <span class=\"customMeta\" data-dictid=\"a1672bc5881692777191cad63bc4a8\">mammography</span> detects <strong>early-stage cancers and <span class=\"customMeta\" data-dictid=\"2c27fdf0ed1692777190530a17c849\">indolent</span> tumors</strong>, leading to <strong>overdiagnosis</strong> and possibly unnecessary treatments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2. <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> cancer screening is done by <span class=\"customMeta\" data-dictid=\"d360d07b701692777186649b62c224\">digital rectal examination</span> (DRE).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>False</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DRE alone is NOT an effective screening test</strong> for <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer. Preferred tests are <strong>colonoscopy, fecal <span class=\"customMeta\" data-dictid=\"c8d9b6cbbb1692777194c4bc31f01f\">occult</span> blood test (FOBT), and fecal <span class=\"customMeta\" data-dictid=\"85c5f08e911692777189af5548bbcb\">immunochemical</span> test (FIT)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3. Oral cancer screening is done by visual inspection.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oral cancer screening involves visual examination and palpation</strong> of the oral mucosa, especially in high-risk individuals (e.g., smokers, <span class=\"customMeta\" data-dictid=\"4b63b4a64c1692777182b509b257e2\">betel</span> nut chewers).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> cancer screening is done by a <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smear.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pap <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> (Papanicolaou test)</strong> detects <strong>cervical <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> and early-stage cancer</strong>, making it the gold standard screening test. <strong>HPV testing is also recommended</strong> in some guidelines.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery for breast carcinoma. She now presents with painless swelling involving the arm, as shown in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lymphedema", "correct": true}, {"label": "B", "text": "Lymphangiosarcoma", "correct": false}, {"label": "C", "text": "Venous thrombosis", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "A. Lymphedema", "question_images": ["https://image.prepladder.com/notes/YDn7eTTM1F3cVyiiXXVS1746451096.png"], "explanation_images": ["https://image.prepladder.com/content/Jr8p8iQDM1dvUBcOLRXJ1745475760.png", "https://image.prepladder.com/content/VWqaRyvHtlCQsaobeCBa1745475760.png", "https://image.prepladder.com/content/qG2R6gOneOrZFvVRDxGB1745475760.png", "https://image.prepladder.com/content/fgFCL6z8KA8o3QDXVawa1745475809.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female presents with a 4 x 3 cm irregular mass in the upper outer quadrant of the right breast, which is not fixed to the skin or the chest wall. A 2 cm lymph node is palpated in the right axilla. No mass is noted in the opposite breast. Which of the following investigations would you perform in this patient? Bilateral Mammography PET Scan Biopsy of the breast mass USG guided biopsy of the lymph node", "options": [{"label": "A", "text": "1, 2, 3 &amp;amp; 4", "correct": false}, {"label": "B", "text": "1, 2 &amp;amp; 3", "correct": false}, {"label": "C", "text": "1, 3 &amp;amp; 4", "correct": false}, {"label": "D", "text": "1 &amp;amp; 3", "correct": true}], "correct_answer": "D. 1 &amp; 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Triple Assessment of Breast Examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Clinical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Objective:</strong> Identify lumps, skin changes, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> discharge, or lymphadenopathy.</p>\n<p><strong>Procedure:</strong> <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">Palpation</span> of breasts and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methods:</strong></p>\n<ul>\n<li><strong>Mammography:</strong> Preferred for women over 40.</li>\n<li><strong>Ultrasound:</strong> Used in younger women or for further evaluation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>FNA:</strong> Minimally invasive; used for <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> lesions.</li>\n<li><strong>Core Needle:</strong> Preferred for solid masses.</li>\n<li><strong>Excisional:</strong> Removes lump for examination.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triple assessment yields more accurate results than individual assessment.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct regarding adequate thyroid FNAC sampling?", "options": [{"label": "A", "text": "6 follicular clusters each with 10 cells each", "correct": true}, {"label": "B", "text": "3 follicular clusters with 10-15 cells each", "correct": false}, {"label": "C", "text": "10 follicular cell clusters with 6-8 cells each", "correct": false}, {"label": "D", "text": "12 follicular cell clusters with 10-12 cells each", "correct": false}], "correct_answer": "A. 6 follicular clusters each with 10 cells each", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>The <span class=\"customMeta\" data-dictid=\"0a01c134f61692777182a529b5493e\">Bethesda System</span> for Reporting <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Cytopathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Usual management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-diagnostic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeat FNAC with <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> guidance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical and <span class=\"customMeta\" data-dictid=\"250ea353d2169277719853a4313f1b\">sonographic</span> follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atypia of undetermined significance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeat FNAC, molecular testing, <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> lobectomy, or surveillance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular neoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>23-34</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular testing, <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> lobectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suspicious for malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>67-83</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular testing, lobectomy, or near-total thyroidectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>97-100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lobectomy or near-total thyroidectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What risks are associated with the initiation of tamoxifen in a patient diagnosed with unilateral breast cancer?", "options": [{"label": "A", "text": "Ovarian cancer", "correct": false}, {"label": "B", "text": "Endometrial cancer", "correct": true}, {"label": "C", "text": "Breast cancer, on the other side", "correct": false}, {"label": "D", "text": "Cervical cancer", "correct": false}], "correct_answer": "B. Endometrial cancer", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:523px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Endometrial <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protective factors </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age (&gt;50 yrs)</li>\n<li>Obesity</li>\n<li>Estrogen exposure</li>\n<li>Nulliparity</li>\n<li>Tamoxifen</li>\n<li>Family history\n\t\t\t\t<ul>\n<li>LYNCH syndrome</li>\n<li>BRCA1 &amp; BRCA2 mutations</li>\n</ul>\n</li>\n<li>Diabetes</li>\n<li>Polycystic <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">ovary</span> syndrome (PCOS)</li>\n<li>Early menarche</li>\n<li>Late menopause</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral contraceptives</li>\n<li>Pregnancy and childbirth</li>\n<li>Regular exercise</li>\n<li>Healthy weight management</li>\n<li>LNG-IUS</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the most likely associated condition with increased TSH and low T4 levels?", "options": [{"label": "A", "text": "Hypoparathyroidism", "correct": false}, {"label": "B", "text": "Pituitary Adenoma", "correct": false}, {"label": "C", "text": "Grave's disease", "correct": false}, {"label": "D", "text": "Hashimoto's thyroiditis", "correct": true}], "correct_answer": "D. Hashimoto's thyroiditis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman presents with complaints of swelling of the right breast over the past 15 days. On examination, there was a local rise in temperature, and the lump was mobile over the chest wall. What is the likely diagnosis?", "options": [{"label": "A", "text": "Inflammatory carcinoma", "correct": true}, {"label": "B", "text": "Giant fibroadenoma", "correct": false}, {"label": "C", "text": "Phyllodes tumour", "correct": false}, {"label": "D", "text": "Galactocele", "correct": false}], "correct_answer": "A. Inflammatory carcinoma", "question_images": ["https://image.prepladder.com/content/IvRxibpx0K3gg9Xoy6Q91745476240.png"], "explanation_images": ["https://image.prepladder.com/content/nQ6vdHfcaHgjusZ1XMor1745476275.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerves is least injured during thyroid surgery?", "options": [{"label": "A", "text": "Recurrent laryngeal nerve", "correct": false}, {"label": "B", "text": "Cervical sympathetic trunk", "correct": false}, {"label": "C", "text": "External laryngeal nerve", "correct": false}, {"label": "D", "text": "Marginal mandibular nerve", "correct": true}], "correct_answer": "D. Marginal mandibular nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications of Thyroidectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bleeding from <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> arteries or slippage of <span class=\"customMeta\" data-dictid=\"3e0d0648b81692777191eca3015435\">ligature</span> from <strong>superior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> vessels.</strong></li>\n<li><strong>Complication: Tension hematom</strong>a causing <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress. <strong>Management:</strong> Immediate re-operation, open sutures, control bleeding, drain hematoma, and close the wound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary Cause:</strong> Laryngeal <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> from <span class=\"customMeta\" data-dictid=\"defdae89701692777187f94861b129\">extubation</span> injury. <strong>(Most Common Complication)</strong></li>\n<li><strong>Other Causes:</strong> RLN <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> and tension hematoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Commonly Injured Nerve:</strong> External branch of the superior laryngeal nerve.</li>\n<li><strong>Other Injuries: RLN Injury </strong>causing <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> and <strong>Cervical <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> trunk</strong> causing<strong> Horner's syndrome.</strong> <strong>(Options A &amp; B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid Insufficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ligating the <strong>inferior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong>away from the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> leads to <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> infarction.</li>\n<li>Causes <strong>hypocalcemia (low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels) </strong>presenting<strong> 2–5 days post-surgery.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyroid Insufficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Total <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">thyroidectomy</span> leads to <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> and requires lifelong levothyroxine replacement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyrotoxic Crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inadequate <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> preparation</strong> in <span class=\"customMeta\" data-dictid=\"236b9106d7169277718961e983707b\">hyperthyroid</span> patients leads to the release of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones during surgery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about the flap given in the image?", "options": [{"label": "A", "text": "Pedicled TRAM based on superior epigastric artery", "correct": false}, {"label": "B", "text": "Free TRAM based on superior and inferior epigastric artery", "correct": false}, {"label": "C", "text": "DIEP based on deep inferior epigastric artery", "correct": true}, {"label": "D", "text": "Lower abdominal fat-based inferior epigastric vessels", "correct": false}], "correct_answer": "C. DIEP based on deep inferior epigastric artery", "question_images": ["https://image.prepladder.com/content/uXgqYgMGS5kkUDMualL11746515823.png"], "explanation_images": ["https://image.prepladder.com/content/D7GddIizWvjkLm15s0ZD1746515872.png", "https://image.prepladder.com/content/xZnFoWVBXzCxtiv1hAgv1746515873.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Breast <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">Reconstruction</span> Flaps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flaps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Correlation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transverse <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">Rectus</span> Abdominis Muscle <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">Flap</span> (TRAM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Free <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> involves using tissue from the abdomen, including both skin and muscle <strong>(Option A ruled out)</strong></li>\n<li>Most commonly used <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> but not the best flap</li>\n<li>It is based on <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels</li>\n<li>Disadvantage: causes weakness in <span class=\"customMeta\" data-dictid=\"fab77fbe55169277719011d192986d\">infra</span> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> region</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/D7GddIizWvjkLm15s0ZD1746515872.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">Perforator</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> (DIEP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flap which uses skin and fat from lower abdomen, but spares <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> muscles</li>\n<li>Best <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> for breast <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> as there is no risk of <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> and muscle weakness</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/xZnFoWVBXzCxtiv1hAgv1746515873.png\" width=\"522\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Latissimus <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">Dorsi</span> Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flap, which uses <span class=\"customMeta\" data-dictid=\"12ad4210e4169277719111f356b7ba\">Latissimus</span> <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">dorsi</span> muscle, skin and fat</li>\n<li>It is a type of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> based on thoracodorsal vessels.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old boy undergoes bilateral adrenalectomy for phaeochromocytoma. On the third postoperative day, the boy feels lethargic and tired. Blood pressure is 80/60 mm Hg; there is no sign of bleeding. What could be the cause of this?", "options": [{"label": "A", "text": "Addisonian crisis", "correct": true}, {"label": "B", "text": "SIADH", "correct": false}, {"label": "C", "text": "Diabetes insipidus", "correct": false}, {"label": "D", "text": "Cerebral salt wasting disease", "correct": false}], "correct_answer": "A. Addisonian crisis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What kind of thyroid cancer is frequently linked to prior radiation exposure, elevated RET/PTC rearrangements, and BRAF mutations?", "options": [{"label": "A", "text": "Follicular carcinoma", "correct": false}, {"label": "B", "text": "Papillary carcinoma", "correct": true}, {"label": "C", "text": "Anaplastic carcinoma", "correct": false}, {"label": "D", "text": "Medullary carcinoma", "correct": false}], "correct_answer": "B. Papillary carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gVk5ZzzZRApuS5GHmqV51746984072.png", "https://image.prepladder.com/content/yAhfUzPeMqqZDrLrQitD1746984072.png", "https://image.prepladder.com/content/iaqXf3BHa234DAQa0ocq1746984073.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:753px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Papillary </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Follicular</strong></p>\n<p><strong>(Option A ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medullary </strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anaplastic</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Para <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Radiation </strong></li>\n<li>Thyroglossal cyst</li>\n<li>Hashimoto’s thyroiditis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Iodine deficiency</li>\n<li>Multinodular goitre</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BRAF, RET-PTC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PAX-8,/PPAR-1, PTEN, P-53, RAS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RET, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>P53</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen in the 3rd to 4th decade.</li>\n<li>Midline <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the neck</li>\n<li>Occasionally, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen in the 5th to 6th decade.</li>\n<li>A sudden increase in the size of the swelling</li>\n<li>Minimal or no pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Raised calcitonin.</li>\n<li>History of diarrhoea</li>\n<li>Family history of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> or hyperparathyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphatic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematogenous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both and Direct invasion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Optically clear <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (Orphan Annie eye nuclei)</li>\n<li>Dystrophic <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> (Psammoma bodies)</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"KGH \" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Thyroid_papillary_carcinoma_histopathology_%282%29.jpg\" data-tags=\"\" height=\"180\" src=\"https://image.prepladder.com/content/gVk5ZzzZRApuS5GHmqV51746984072.png\" width=\"239\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicles (multiple <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> are seen)</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Follicular_thyroid_cancer#/media/File:Follicular_thyroid_carcinoma_2_--_low_mag.jpg\" data-tags=\"\" height=\"179\" src=\"https://image.prepladder.com/content/yAhfUzPeMqqZDrLrQitD1746984072.png\" width=\"264\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amyloid deposition</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Medullary_thyroid_carcinoma_-_2_-_high_mag.jpg#/media/File:Medullary_thyroid_carcinoma_-_low_mag.jpg\" data-tags=\"\" height=\"177\" src=\"https://image.prepladder.com/content/iaqXf3BHa234DAQa0ocq1746984073.png\" width=\"261\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Highly <span class=\"customMeta\" data-dictid=\"d391ed597c1692777195574de6cc11\">pleomorphic</span> cells, <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells, giant cells, often areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and mitotic figures.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Best way to localise extra-adrenal pheochromocytoma:", "options": [{"label": "A", "text": "X-ray", "correct": false}, {"label": "B", "text": "Nucleotide scan", "correct": true}, {"label": "C", "text": "VMA excretion", "correct": false}, {"label": "D", "text": "Clinical examination", "correct": false}], "correct_answer": "B. Nucleotide scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Grey-Turner's sign is seen in:", "options": [{"label": "A", "text": "Acute appendicitis", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute cholecystitis", "correct": false}, {"label": "D", "text": "Acute hepatitis", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/N64enWH3mXR40dR9pBYL1747122975.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman after thyroidectomy comes to you for a 2 nd opinion for further treatment of papillary thyroid cancer. What would you recommend for this patient?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Chemotherapy", "correct": false}, {"label": "C", "text": "Radioiodine scan", "correct": true}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "C. Radioiodine scan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancers\n\t\t\t\t<ul>\n<li>E.g., <strong>Papillary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></li>\n<li><strong>Follicular <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></li>\n<li><strong>Hurthle cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></li>\n</ul>\n</li>\n<li>Tumor size <strong>&gt;2cm</strong></li>\n<li>One or more risk factors</li>\n<li>Obvious <span class=\"customMeta\" data-dictid=\"756a84577116927771871853f8642e\">extrathyroidal</span> extension</li>\n<li>&gt;45 years of age</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> and distant metastasis</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Poorly differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancers\n\t\t\t\t<ul>\n<li>E.g., <strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></li>\n<li>Anaplastic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</li>\n</ul>\n</li>\n<li>Pregnancy &amp; Breastfeeding<strong> (Absolute contraindications)</strong></li>\n<li>Vomiting &amp; <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> (Relative contraindications)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:747px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Isotopes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Route of administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Half-life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of rays </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-123</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> purposes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-124</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PET scan in <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-125 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnostic purposes and, in some cases, for brachytherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-131</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>𝜷 and 𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radioactive <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-132</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.3 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in research</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tc-99 scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technetium is better at identifying non-functioning secondaries.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male presents with a serum calcium level of 12.8 mg/dL (normal range: 8.5–10.25 mg/dL) along with elevated parathyroid hormone (PTH) levels. Ultrasound imaging reveals a 1.5 x 1.5 cm mass in the right lower lobe of the thyroid gland. Which of the following statements is correct regarding this condition?", "options": [{"label": "A", "text": "MIBI followed by focussed parathyroidectomy to be done", "correct": true}, {"label": "B", "text": "Normal DEXA scan rules out the need for surgery", "correct": false}, {"label": "C", "text": "Only observation, no need for surgery", "correct": false}, {"label": "D", "text": "Creatinine clearance &amp;gt; 80 ml/min mandates the surgery", "correct": false}], "correct_answer": "A. MIBI followed by focussed parathyroidectomy to be done", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of MEN2B syndrome?", "options": [{"label": "A", "text": "Medullary thyroid carcinoma", "correct": false}, {"label": "B", "text": "Mucosal ganglioneuromatosis", "correct": false}, {"label": "C", "text": "Marfanoid habitus", "correct": false}, {"label": "D", "text": "Parathyroid hyperplasia", "correct": true}], "correct_answer": "D. Parathyroid hyperplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:797px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> Neoplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type IV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defect of chr.10 leading to <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <strong>RET gene</strong></li>\n<li>Also called <strong>Sipple’s syndrome </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Also called <strong>MEN II B</strong>, it is a <strong>variant of <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> </strong>MEN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect of chr.12 causing <strong>CDKN1B gene</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n<p><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid adenoma</strong></p>\n<p>(most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> and ↑ Ca)</li>\n<li>All the four glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>most common, and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> can be normal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (</strong>most common)</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>Presents as hypercalcemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma</strong>.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma </strong>(Most important <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> for both <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2 and <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 3): Presents with elevated blood pressure.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></p>\n<ul>\n<li>Calcitonin is the <span class=\"customMeta\" data-dictid=\"19ae68448b16927772016d48bd7fc3\">tumor marker</span> present</li>\n<li>Cold nodules are seen on the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> scan</li>\n<li>Metastasis can be traced with PET scan</li>\n<li>Visible neck mass, causing dysphagia</li>\n<li><strong>Rx</strong>- <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">Prophylactic</span> thyroidectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reproductive <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> tumors</strong></p>\n<ul>\n<li>Testicular tumours</li>\n<li>Neuroendocrine tumor (Cervix)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital aganglionosis,</li>\n<li>Hirschsprung disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marfanoid <span class=\"customMeta\" data-dictid=\"8ee388400616927771886d002873d3\">habitus</span> <strong>(Option C ruled out)</strong></li>\n<li>Medullated corneal nerve fibers</li>\n<li>Mucosal neuromas <strong>(Option B ruled out)</strong></li>\n<li>Megacolon and Multiple diverticulae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occasionally with</p>\n<ul>\n<li>Renal tumour</li>\n<li>Adrenal tumour</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents with occasional palpitations, high blood pressure, and headache. He is diagnosed with pheochromocytoma. What is the preferred initial investigation?", "options": [{"label": "A", "text": "USG-abdomen", "correct": false}, {"label": "B", "text": "MRI - abdomen", "correct": false}, {"label": "C", "text": "MIBG", "correct": false}, {"label": "D", "text": "24 hours urine metanephrines", "correct": true}], "correct_answer": "D. 24 hours urine metanephrines", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pheochromocytoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A catecholamine-secreting tumour that arises from the <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> chain/ <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla</li>\n<li>Co-exist with neurofibromatosis, VHL syndrome, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Classical triad: Headache (most common), profuse sweating, <span class=\"customMeta\" data-dictid=\"c226fe76dd1692777194b984788b28\">palpitation</span> and tachycardia</li>\n</ul>\n<ul>\n<li>Hypertension (sustained or intermittent)</li>\n<li>Anxiety, panic attacks</li>\n<li>Hyperglycemia and Hypercalcemia</li>\n<li>Pallor (due to alpha-1 mediated vasoconstriction)</li>\n<li>Polyuria and polydipsia</li>\n<li>Orthostatic hypotension</li>\n<li>Dilated cardiomyopathy</li>\n<li>Erythrocytosis</li>\n<li>Constipation</li>\n<li>Abdominal pain</li>\n<li>Weakness</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The rule of 10</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>10% are bilateral</li>\n<li>10% are extra-adrenal</li>\n<li>10% are malignant</li>\n<li>25-33% are inherited</li>\n<li>Symptomatic patients do not follow the Rule of 10’s</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Measurement of the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> fractionated metanephrines is the most sensitive screening test; hence, the initial investigation is preferred.</li>\n<li>Increase 24 hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> VMA(Vanillyl mandelic acid) and metanephrines <strong>(Option D)</strong></li>\n<li>MRI is the investigation of choice. <strong>(Option B ruled out)</strong></li>\n<li>Biopsy and CT contrast scans are contraindicated in order to avoid <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> crises</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adrenalectomy</strong> is the treatment of choice</li>\n<li>Size&lt;5cm- <strong>Laparoscopic adrenalectomy</strong></li>\n<li>Preop Alpha-blockers should be given</li>\n<li>Mitotane should be started as <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> or <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> treatment</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most lethal nerve injury during thyroid surgery?", "options": [{"label": "A", "text": "U/L RLN (partial)", "correct": false}, {"label": "B", "text": "B/L RLN (partial)", "correct": false}, {"label": "C", "text": "U/L RLN (complete)", "correct": false}, {"label": "D", "text": "B/L RLN (complete)", "correct": true}], "correct_answer": "D. B/L RLN (complete)", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common cause of bloody nipple discharge?", "options": [{"label": "A", "text": "Breast cancer", "correct": false}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Intraductal papilloma", "correct": true}, {"label": "D", "text": "Duct Ectasia", "correct": false}], "correct_answer": "C. Intraductal papilloma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">Nipple</span> Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bloody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">Papilloma</span> (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrocystic Disease (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greenish/Blackish</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Milk (Galactorrhea)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological (e.g., Pregnancy, Lactation)</li>\n<li>Hyperprolactinemia (e.g., <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">Pituitary</span> Adenoma, Hypothyroidism)</li>\n<li>Medications (e.g., Antipsychotics, Antidepressants, Oral Contraceptives)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purulent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breast Abscess</li>\n<li>Mastitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where Tsh level is 27.3mU/L, T3 is 1.24 ng/ml, and T4 is 4.87 microgram/ml. Which of the following manifestations is true regarding the condition?", "options": [{"label": "A", "text": "Heat intolerance", "correct": false}, {"label": "B", "text": "Tachycardia", "correct": false}, {"label": "C", "text": "Diarrhea", "correct": false}, {"label": "D", "text": "Weight gain", "correct": true}], "correct_answer": "D. Weight gain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hyperthyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight gain, puffiness, dry skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased appetite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased appetite</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bradycardia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cold intolerance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heat intolerance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constipation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Menorrhagia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amenorrhea, infertility</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiomegaly, <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiovascular complications such as atrial fibrillation, cardiomyopathy, and Congestive heart failure.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Altered mental status, coma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presents with an irregular 5 x 6 cm mass in the right breast. Histopathological examination reveals findings consistent with which of the following diagnoses?", "options": [{"label": "A", "text": "Phylloid tumor", "correct": true}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Mastitis", "correct": false}, {"label": "D", "text": "Grade 2 breast tumor", "correct": false}], "correct_answer": "A. Phylloid tumor", "question_images": ["https://image.prepladder.com/content/BdxjqgKtJAQxOqdEPF171724910270.png"], "explanation_images": ["https://image.prepladder.com/content/05OBrUo1PNUnoViyVgOv1724851533.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5ea5a8a7d71692777195dd957c9057\"&gt;Phyllodes&lt;/span&gt; tu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the outpatient department with an ulcerated breast tumor and liver metastasis. What is the appropriate management?", "options": [{"label": "A", "text": "Simple mastectomy", "correct": false}, {"label": "B", "text": "Modified Radical Mastectomy (MRM)", "correct": false}, {"label": "C", "text": "Radical mastectomy", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy followed by surgery", "correct": true}], "correct_answer": "D. Neoadjuvant chemotherapy followed by surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Neoadjuvant &lt;span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\"&gt;chemotherapy&lt;/span&gt; followed by surg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presented with 1x 1 cm thyroid swelling. What is next best step in management?", "options": [{"label": "A", "text": "I 131", "correct": false}, {"label": "B", "text": "TSH", "correct": false}, {"label": "C", "text": "TSH and T4", "correct": true}, {"label": "D", "text": "T3 and T4", "correct": false}], "correct_answer": "C. TSH and T4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - TSH and T4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a swelling in the thyroid region that moves with deglutination and protrusion of the tongue. The swelling has ruptured, resulting in pus discharge. What is the preferred treatment?", "options": [{"label": "A", "text": "Sistrunk procedure", "correct": true}, {"label": "B", "text": "Antibiotics", "correct": false}, {"label": "C", "text": "Incision and drainage", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Sistrunk procedure", "question_images": ["https://image.prepladder.com/content/QoOVBLOlPHru07eRqGdE1747293410.png"], "explanation_images": ["https://image.prepladder.com/content/F4fu0kqF14aNn2emdcBY1747293450.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an indication for parathyroidectomy in a patient with primary hyperparathyroidism?", "options": [{"label": "A", "text": "Serum calcium &amp;gt; 1 mg/dL above the upper limit of normal", "correct": false}, {"label": "B", "text": "24-hour urine calcium &amp;gt; 400 mg/d", "correct": false}, {"label": "C", "text": "Age &amp;lt; 50 years", "correct": false}, {"label": "D", "text": "Creatinine clearance &amp;lt; 90 mL/min", "correct": true}], "correct_answer": "D. Creatinine clearance &lt; 90 mL/min", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man with a history of renal calculi presents with bone pain and abdominal cramps. X-ray shows subperiosteal resorption of the 2nd and 3rd metacarpals and phalanges. Serum calcium and PTH are raised, and phosphate levels are decreased. Which of the following investigations will help localise the pathology?", "options": [{"label": "A", "text": "99Tc radiolabelled sestamibi scan", "correct": true}, {"label": "B", "text": "MRI scan", "correct": false}, {"label": "C", "text": "USG", "correct": false}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "A. 99Tc radiolabelled sestamibi scan", "question_images": ["https://image.prepladder.com/content/UOUPAYAe8sQSuywREtna1747302361.png"], "explanation_images": ["https://image.prepladder.com/notes/3gAzImx6GBL1f5AJ95Ft1747648760.png", "https://image.prepladder.com/notes/SbZQtPKclcRuCZZUFMuS1747648779.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intact PTH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Low or inappropriately high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum phosphate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chloride to <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> ratio </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>1,25- <span class=\"customMeta\" data-dictid=\"147defe59f16927771894a7addb83d\">hydroxy</span> Vitamin D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Normal or raised</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with polyuria, polydipsia, lethargy, and abdominal pain. She also has a history of mood disorders and recurrent kidney stones. Which of the following investigations would not be useful in arriving at the diagnosis?", "options": [{"label": "A", "text": "Nuclear sestamibi scan", "correct": false}, {"label": "B", "text": "USG neck", "correct": false}, {"label": "C", "text": "Dual-energy radiographic absorptiometry (DEXA)", "correct": false}, {"label": "D", "text": "Angiography of renal arteries", "correct": true}], "correct_answer": "D. Angiography of renal arteries", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred treatment for a benign tumour of the superficial parathyroid gland?", "options": [{"label": "A", "text": "Enucleation", "correct": false}, {"label": "B", "text": "Surgical resection", "correct": true}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Radiation therapy", "correct": false}], "correct_answer": "B. Surgical resection", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gimye1paKmFMoWMiN0IE1747649126.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "ER positivity is used as which of the following in the context of breast carcinoma?", "options": [{"label": "A", "text": "Diagnostic marker", "correct": false}, {"label": "B", "text": "Prognostic marker", "correct": true}, {"label": "C", "text": "Surrogate molecular marker", "correct": false}, {"label": "D", "text": "treatment", "correct": false}], "correct_answer": "B. Prognostic marker", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\"&gt;Prognostic&lt;/span&gt; marker:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ER +ve status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ER -ve status</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prognosis is good.</li>\n<li>Hormone therapy including tamoxifen is more beneficial.</li>\n<li>Response to treatment is better.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prognosis is poor.</li>\n<li>Hormone therapy is not very beneficial (but used) as compared to ER +ve patients.</li>\n<li>Response to treatment is not good.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following will not result in hoarseness of voice after a thyroid surgery?", "options": [{"label": "A", "text": "Dissecting/retracting strap muscles", "correct": false}, {"label": "B", "text": "Exploring Beahrs triangle", "correct": false}, {"label": "C", "text": "Tubercle of zuckerkandl dissection", "correct": false}, {"label": "D", "text": "Ligating superior thyroid vessels", "correct": true}], "correct_answer": "D. Ligating superior thyroid vessels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ligating superior &lt;span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\"&gt;thyroid&lt;/span&gt; v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old lactating mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?", "options": [{"label": "A", "text": "Breast engorgement", "correct": false}, {"label": "B", "text": "Hormonal influence", "correct": false}, {"label": "C", "text": "Absence of lactation", "correct": false}, {"label": "D", "text": "Crack in the nipple", "correct": true}], "correct_answer": "D. Crack in the nipple", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Genetic testing for BRCA 1/BRCA 2 is indicated for all of the following except:", "options": [{"label": "A", "text": "Breast cancer diagnosed in a postmenopausal female &amp;gt;50 years of age", "correct": true}, {"label": "B", "text": "Male breast cancer", "correct": false}, {"label": "C", "text": "Two breast cancer primaries", "correct": false}, {"label": "D", "text": "TNBC diagnosed age 60 years", "correct": false}], "correct_answer": "A. Breast cancer diagnosed in a postmenopausal female &gt;50 years of age", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with invasive ductal carcinoma in situ presents with ulceration on skin and inflammatory signs. Nipple retraction was also present. What is the stage?", "options": [{"label": "A", "text": "Stage 3b", "correct": true}, {"label": "B", "text": "Stage 4 with node positivity", "correct": false}, {"label": "C", "text": "T4b", "correct": false}, {"label": "D", "text": "No metastasis", "correct": false}], "correct_answer": "A. Stage 3b", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Stage 3b:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>When T is </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>When N is </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>When M is </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>T4a- Extension to <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> Ribs + <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> muscles + <span class=\"customMeta\" data-dictid=\"2462a1d0cf16927771985f03ba098b\">Serratus</span> anterior</li>\n<li>T4b- The skin changes are involved (All the changes should be confined to the same breast)\n\t\t\t\t<ul>\n<li>Ulceration</li>\n<li>Edema including Peau-D' orange</li>\n<li>Satellite nodules</li>\n</ul>\n</li>\n<li>T4c- T4a + T4b</li>\n<li>T4d- <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> breast cancer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>N0- No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</li>\n<li>N1- <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> to <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> level I and II (mobile)</li>\n<li>N2- <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> to <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> level I and II (fixed/matted)</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>M0- No clinical or radiological distant metastasis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 51-year-old lady presents with complaints of a mass in the right breast. On examination, the mass was larger than 5 cm and ipsilateral mobile axillary lymph nodes were present. What is the staging, considering the mass is malignant?", "options": [{"label": "A", "text": "cT3N1M0", "correct": true}, {"label": "B", "text": "cT4N0M0", "correct": false}, {"label": "C", "text": "cT4N1M0", "correct": false}, {"label": "D", "text": "cT3N0M0", "correct": false}], "correct_answer": "A. cT3N1M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor size (T)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary tumor cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No evidence of primary tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (DCIS, LCIS, or Paget's disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor ≤ 2 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1mi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor ≤ 1 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 1 mm but ≤ 5 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 5 mm but ≤ 10 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 10 mm but ≤ 20 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 2 cm but ≤ 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor of any size with direct extension to <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> or skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extension to the chest wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulceration or skin nodules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both T4a and T4b</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4d</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inflammatory breast cancer</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Node (N)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastases to movable <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> level I, II axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or clinically apparent internal mammary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes that are clinically fixed or matted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to internal mammary nodes without axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> nodes, or to <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to internal mammary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis (M)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with a BIRADS-5 breast lesion. Which of the following is a good prognostic factor for this lesion?", "options": [{"label": "A", "text": "BRCA-1 positive", "correct": false}, {"label": "B", "text": "p53 positive", "correct": false}, {"label": "C", "text": "ER positive", "correct": true}, {"label": "D", "text": "High Ki-67", "correct": false}], "correct_answer": "C. ER positive", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histologic Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Invasive Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (IDC): <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">Prognosis</span> varies by <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> and molecular markers.</li>\n<li>Invasive Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (ILC): <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">Intermediate</span> prognosis.</li>\n<li>Tubular and <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> Carcinomas: Best prognosis.</li>\n<li>Basal-like Breast Cancer: Aggressive, triple-negative, no targeted treatments.</li>\n<li>Other Subtypes: Medullary, cribriform, papillary, <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> cystic, and <span class=\"customMeta\" data-dictid=\"03f835a65f169277719239326cc094\">metaplastic</span> carcinomas vary in prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Size &amp; <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pathologic <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> (tumour size, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes) guides <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and treatment.</li>\n<li>Larger tumours and positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes = worse prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Molecular Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hormone Receptors (ER, PR)</strong>:</li>\n<li><strong>ER-positive = better prognosis</strong>, responsive to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy.</li>\n<li><strong>HER-2 Status:</strong> HER-2 positive = aggressive but treatable with targeted therapies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Patient factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Younger, particularly <span class=\"customMeta\" data-dictid=\"a9f4834def16927771962441e4ed98\">premenopausal</span> women, may have higher local <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates post-surgery, but radiation therapy can reduce this risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BRCA Mutation</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally more aggressive and associated with poorer prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A strong family history may indicate inherited <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> and potentially a worse prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prior Breast Cancer History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previous breast cancer can negatively influence the <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> of a new diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lifestyle Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obesity and <span class=\"customMeta\" data-dictid=\"66aad2dcdb169277719098b25eec8c\">inactivity</span> are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to increased <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk and may affect overall prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Adherence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-compliance can worsen prognosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary prognostic factor that significantly influences the outcome of breast cancer?", "options": [{"label": "A", "text": "Lymph node", "correct": true}, {"label": "B", "text": "Distant metastasis", "correct": false}, {"label": "C", "text": "Size", "correct": false}, {"label": "D", "text": "Hormone receptors", "correct": false}], "correct_answer": "A. Lymph node", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histologic Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (IDC): <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">Prognosis</span> varies by <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> and molecular markers.</li>\n<li>Invasive Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (ILC): <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">Intermediate</span> prognosis.</li>\n<li>Tubular and <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> Carcinomas: Best prognosis.</li>\n<li>Basal-like Breast Cancer: Aggressive, triple-negative, no targeted treatments.</li>\n<li>Other Subtypes: Medullary, cribriform, papillary, <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> cystic, and <span class=\"customMeta\" data-dictid=\"03f835a65f169277719239326cc094\">metaplastic</span> carcinomas vary in prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Size &amp; <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pathologic <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> (tumour size, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes) guides <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and treatment.</li>\n<li>Larger tumours and positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes = worse prognosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hormone Receptors (ER, PR): ER-positive = better prognosis, responsive to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy.</li>\n<li>HER-2 Status: HER-2 positive = aggressive but treatable with targeted therapies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Patient factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Younger, particularly <span class=\"customMeta\" data-dictid=\"a9f4834def16927771962441e4ed98\">premenopausal</span> women, may have higher local <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates post-surgery, but radiation therapy can reduce this risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BRCA Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally more aggressive and associated with poorer prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A strong family history may indicate inherited <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> and potentially a worse prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prior Breast Cancer History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Previous breast cancer can negatively influence the <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> of a new diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obesity and <span class=\"customMeta\" data-dictid=\"66aad2dcdb169277719098b25eec8c\">inactivity</span> are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to increased <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk and may affect overall prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Adherence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-compliance can worsen prognosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female presents with a breast lump and is seeking medical evaluation. On examination, a palpable mass is detected in the breast. Which of the following conditions is not associated with the development of breast cancer?", "options": [{"label": "A", "text": "Alcohol intake", "correct": false}, {"label": "B", "text": "Late menopause", "correct": false}, {"label": "C", "text": "Hormone replacement therapy", "correct": false}, {"label": "D", "text": "Multiparity", "correct": true}], "correct_answer": "D. Multiparity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Relative risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Female gender.</li>\n<li>Increasing age.</li>\n<li>Germline mutations of high penetrance.</li>\n<li>Strong family history (&gt;1 first-degree relative, young age, multiple cancers).</li>\n<li>Personal history of breast cancer.</li>\n<li>High breast density.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;4.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Germline mutations of moderate penetrance.</li>\n<li>High-dose radiation to the chest at a young age.</li>\n<li>Family history (1 first-degree relative).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2.1-4.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early <span class=\"customMeta\" data-dictid=\"642d0c7609169277719265439d8047\">menarche</span> (age &lt;12 years)</li>\n<li><strong>Late <span class=\"customMeta\" data-dictid=\"516cc2e77d169277719213e7926b59\">menopause</span> (age &gt;55 years) </strong><strong>(Option B)</strong></li>\n<li>Late first pregnancy (age &gt;35 years).</li>\n<li>Nulliparity.</li>\n<li>Absence of breastfeeding.</li>\n<li><strong>Exogenous <span class=\"customMeta\" data-dictid=\"be711e5c8316927771895447e0d316\">hormone therapy</span> </strong><strong>(Option C)</strong></li>\n<li>Postmenopausal obesity.</li>\n<li>Physical inactivity.</li>\n<li><strong>High alcohol consumption </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1.1-2.0</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relative risk is the likelihood of developing <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> compared to women without any risk factors.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old female patient presents with HER-2-positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment. Which of the following options would be the most appropriate choice?", "options": [{"label": "A", "text": "Lapatinib", "correct": true}, {"label": "B", "text": "Sorafenib", "correct": false}, {"label": "C", "text": "Vemurafenib", "correct": false}, {"label": "D", "text": "Erlotinib", "correct": false}], "correct_answer": "A. Lapatinib", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Targeted Therapy:</strong> Specific for HER2-positive cancers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trastuzumab, Pertuzumab, <strong>Lapatinib</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapy:</strong> Addresses <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Taxanes, Anthracyclines, Capecitabine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormonal Therapy: </strong>For hormone receptor-positive cases (not standalone for HER2-positive)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tamoxifen, <span class=\"customMeta\" data-dictid=\"b249ba1c6a16927771821b83b1fd9b\">Aromatase</span> Inhibitors (if combined)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palliative Surgery: </strong>Relieves significant symptoms from primary tumour growth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mastectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy:</strong> Controls localised symptoms, especially bone metastases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>_</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone-targeted Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Manages bone <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> and reduces skeletal-related events</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bisphosphonates, Denosumab</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following condition is depicted in the given CT image ?", "options": [{"label": "A", "text": "Cirrhosis", "correct": false}, {"label": "B", "text": "HCC", "correct": false}, {"label": "C", "text": "Congenital Adrenal Hyperplasia", "correct": true}, {"label": "D", "text": "Hepatitis", "correct": false}], "correct_answer": "C. Congenital Adrenal Hyperplasia", "question_images": ["https://image.prepladder.com/content/44ujWdFrdwneABk7iBE51692688485.jpeg"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\"&gt;Adrenal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\"&gt;Hyperplasia&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a known history of rheumatoid arthritis is brought to the ER due to dizziness. Her blood pressure is 90/60 mmHg. She stopped taking a medication prescribed by her local doctor. Her blood sugar is low, and serum potassium is 6 mEq/L. Which of the following drugs should be given to her next?", "options": [{"label": "A", "text": "IV Saline", "correct": false}, {"label": "B", "text": "Hydrocortisone", "correct": true}, {"label": "C", "text": "Dopamine infusion", "correct": false}, {"label": "D", "text": "Sodium bicarbonate", "correct": false}], "correct_answer": "B. Hydrocortisone", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Clinical features Glucocorticoid insufficiency: Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, hyponatremia (dilutional), hypercalcemia Mineralocorticoid insufficiency Hypotension, shock, hyponatremia, hyperkalemia ACTH excess: Pigmentation Adrenal androgen insufficiency: Decreased body hair and loss of libido, especially in females</li><li>↳ Clinical features</li><li>↳ Clinical features</li><li>↳ Clinical features</li><li>↳ Glucocorticoid insufficiency: Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, hyponatremia (dilutional), hypercalcemia Mineralocorticoid insufficiency Hypotension, shock, hyponatremia, hyperkalemia ACTH excess: Pigmentation Adrenal androgen insufficiency: Decreased body hair and loss of libido, especially in females</li><li>↳ Glucocorticoid insufficiency: Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, hyponatremia (dilutional), hypercalcemia Mineralocorticoid insufficiency Hypotension, shock, hyponatremia, hyperkalemia ACTH excess: Pigmentation Adrenal androgen insufficiency: Decreased body hair and loss of libido, especially in females</li><li>↳ Glucocorticoid insufficiency: Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, hyponatremia (dilutional), hypercalcemia</li><li>↳ Glucocorticoid insufficiency:</li><li>↳ Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, hyponatremia (dilutional), hypercalcemia</li><li>↳ Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, hyponatremia (dilutional), hypercalcemia</li><li>↳ Mineralocorticoid insufficiency Hypotension, shock, hyponatremia, hyperkalemia</li><li>↳ Mineralocorticoid insufficiency</li><li>↳ Hypotension, shock, hyponatremia, hyperkalemia</li><li>↳ Hypotension, shock, hyponatremia, hyperkalemia</li><li>↳ ACTH excess: Pigmentation</li><li>↳ ACTH excess:</li><li>↳ Adrenal androgen insufficiency: Decreased body hair and loss of libido, especially in females</li><li>↳ Adrenal androgen insufficiency:</li><li>↳ Investigations Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency. Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency. Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency. Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency)</li><li>↳ Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency.</li><li>↳ Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency)</li><li>↳ Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women</li><li>↳ Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Management Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used. Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used. Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used. Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used.</li><li>↳ Glucocorticoid Replacement:</li><li>↳ Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ Mineralocorticoid Replacement:</li><li>↳ Addisonian crisis An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery). Management: IV Hydrocortisone</li><li>↳ Addisonian crisis</li><li>↳ Addisonian crisis</li><li>↳ Addisonian crisis</li><li>↳ An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery). Management: IV Hydrocortisone</li><li>↳ An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery). Management: IV Hydrocortisone</li><li>↳ An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery).</li><li>↳ Addisonian crisis</li><li>↳ Addison's disease</li><li>↳ Management: IV Hydrocortisone</li><li>↳ Management: IV Hydrocortisone</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Glucocorticoid insufficiency:</strong>\n<ul>\n<li>Weight loss, anorexia, malaise, weakness, nausea, vomiting, diarrhoea or constipation, postural hypotension, shock, hypoglycemia, <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> (dilutional), hypercalcemia</li>\n</ul>\n</li>\n<li><strong>Mineralocorticoid insufficiency</strong>\n<ul>\n<li>Hypotension, shock, hyponatremia, hyperkalemia</li>\n</ul>\n</li>\n<li><strong>ACTH excess:</strong> Pigmentation</li>\n<li><strong>Adrenal <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> insufficiency:</strong> Decreased body hair and loss of libido, especially in females</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Random <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> measurement (values &gt;500 nmol/L exclude <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency)</li>\n<li>Short <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> test- if random <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels are between 100-500, 1 <span class=\"customMeta\" data-dictid=\"c61e3b709016927771920d8bd6503d\">microgram</span> ACTH, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels of &lt;500 is considered confirmatory for <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency.</li>\n<li>Plasma <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> and <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> (high <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> with low/lower part of the reference range <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> in <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">mineralocorticoid</span> deficiency)</li>\n<li>Dehydroepiandrosterone <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> (DHEAS) and <span class=\"customMeta\" data-dictid=\"2b218bfcc816927771817d02ae5257\">androstenedione</span> in women</li>\n<li>Adrenal autoantibodies for <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> causes; <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (CT/MRI) if antibodies are negative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Glucocorticoid Replacement:</strong> Oral <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> is preferred, and <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">Prednisolone</span> and <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> may also be used.</li>\n<li><strong>Mineralocorticoid Replacement:</strong> Fludrocortisone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Addisonian crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>An <strong>Addisonian crisis</strong> is a life-threatening medical emergency that occurs when there is a severe <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and aldosterone. It is most commonly seen in people with <strong>Addison's disease</strong> (primary <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery).</li>\n<li><strong>Management: IV <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">Hydrocortisone</span> </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best method to conclusively localize a parathyroid adenoma?", "options": [{"label": "A", "text": "SPECT Sestamibi", "correct": true}, {"label": "B", "text": "Tc99 Sestamibi Scan", "correct": false}, {"label": "C", "text": "USG Neck", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "A. SPECT Sestamibi", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/PYsY8QG57IQBzPalnA6B1746183486.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs are not used for thyrotoxic crisis management?", "options": [{"label": "A", "text": "Acetaminophen", "correct": false}, {"label": "B", "text": "Aspirin", "correct": true}, {"label": "C", "text": "Lugol's iodine", "correct": false}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "B. Aspirin", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Thyroid Storm</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> storm, or <span class=\"customMeta\" data-dictid=\"d1ad396c00169277720080f8a84f23\">thyrotoxic</span> crisis, is an acute, life-threatening <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of hyperthyroidism.</li>\n<li>It presents with multisystem involvement and has a mortality rate of 8 to 25% despite advancements in treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most commonly associated with<strong> Graves' disease</strong> but can also occur in toxic <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">multinodular</span> <span class=\"customMeta\" data-dictid=\"10ccb423ae1692777188f2ffbb4491\">goitre</span> and toxic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> adenoma.</li>\n<li>Precipitating Factors:\n\t\t\t\t<ul>\n<li>Abrupt discontinuation of <span class=\"customMeta\" data-dictid=\"aa309b5abf1692777181f01d769dd7\">antithyroid</span> medications.</li>\n<li>Thyroid surgery.</li>\n<li>Non-thyroid surgery.</li>\n<li>Acute illnesses (e.g., infections, <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis, myocardial infarction, stroke) act as stressors that can trigger <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone release.</li>\n<li>Parturition (childbirth).</li>\n<li>Recent use of iodinated contrast medium.</li>\n<li>Trauma or Burns or <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> brain injury.</li>\n<li>Medication side effects (e.g., amiodarone, anaesthetics, salicylates).</li>\n<li>Raised beta-hcg conditions such as complete mole, twin pregnancies</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fever:</strong> High temperature (104°F to 106°F) with diaphoresis.</li>\n<li><strong>Cardiovascular Involvement:</strong> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> (&gt;140 bpm), heart failure, arrhythmias, hypotension, and risk of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</li>\n<li><strong>CNS Manifestations:</strong> Agitation, delirium, anxiety, psychosis, or coma.</li>\n<li><strong>Gastrointestinal Symptoms:</strong> Nausea, vomiting, diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, intestinal obstruction, and <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure.</li>\n<li><strong>Physical Exam Findings:</strong> Tachycardia, goitre, hand tremors, moist and warm skin, hyperreflexia, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> hypertension, and jaundice.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Supportive Measures:</strong> IV fluids, oxygen, <span class=\"customMeta\" data-dictid=\"579dcf5fc51692777185eef17a83c6\">cooling</span> blankets, and <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> <strong>(Option A)</strong>.</li>\n<li><strong>Beta-blocker Therapy:</strong> Start with <strong>propranolol (Option D)</strong> immediately (40-80 mg every 4-6 hours) to control <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> tone.</li>\n<li><strong>Thionamide Therapy:</strong> Administer <span class=\"customMeta\" data-dictid=\"34735bff271692777196f13335f804\">propylthiouracil</span> (500-1000 mg loading, then 250 mg every 4 hours) or <span class=\"customMeta\" data-dictid=\"5bd74cc52b1692777192ca3ad5ee2a\">methimazole</span> (20 mg every 4-6 hours). This <strong>reduces <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone synthesis.</strong></li>\n<li><strong>Iodine Solution (Option C):</strong> Give <span class=\"customMeta\" data-dictid=\"6548de32621692777199a76c7d3ba9\">SSKI</span> (5 drops every 6 hours) after thionamide to <strong>reduce the release of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone</strong></li>\n<li><strong>Glucocorticoids:</strong> <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">Hydrocortisone</span> (100 mg IV every 8 hours) or <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> (2 mg every 6 hours).</li>\n<li>Therapy<strong> to block <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> conversion of T4 to T3</strong>: Iodinated <span class=\"customMeta\" data-dictid=\"807750980116927771978f8890bd5c\">radiocontrast</span> agent, glucocorticoid, PTU, propranolol</li>\n<li><strong>Cholestyramine</strong> (Bile acid sequestrant)<strong>:</strong> 4 grams orally 4 times daily for severe cases to reduce <span class=\"customMeta\" data-dictid=\"6fa49bcdd91692777187965db2303d\">enterohepatic</span> recycling of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone.</li>\n<li><strong>Monitoring:</strong> Admit to <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> with close <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> monitoring and <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> support if needed.</li>\n<li><strong>Alternative Medications:</strong> Esmolol as a short-acting beta-blocker; <strong>diltiazem if beta-blockers are contraindicated.</strong></li>\n<li><strong>Surgery:</strong> <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">Thyroidectomy</span> for patients with contraindications to thionamides after pre-treatment.</li>\n<li><strong>Definitive Treatment:</strong> Recommend <span class=\"customMeta\" data-dictid=\"2a445711f21692777197336861a4ac\">radioiodine</span> therapy or surgery for <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">hyperthyroidism</span> once stabilized.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the most common pancreatic islet tumor associated with MEN-1 syndrome.", "options": [{"label": "A", "text": "VIPoma", "correct": false}, {"label": "B", "text": "Gastrinoma", "correct": true}, {"label": "C", "text": "Insulinoma", "correct": false}, {"label": "D", "text": "Lipoma", "correct": false}], "correct_answer": "B. Gastrinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Gastrinoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> Neoplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type IV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of chr.10 leading to <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <strong>RET gene</strong></li>\n<li>Also called <strong>Sipple’s syndrome </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Also called <strong>MEN II B</strong>, it is a <strong>variant of Type 2 </strong>MEN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defect of chr.12 causing <strong>CDKN1B gene</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n<p><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid adenoma </strong>(most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ PTH and ↑ Ca)</li>\n<li>All the 4 glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>most common, and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> can be normal)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (</strong>most common)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>Presents as hypercalcemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pheochromocytoma</strong>.</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pheochromocytoma </strong>(Most important <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> for both <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2 and <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 3): Presents with elevated blood pressure.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></p>\n<ul>\n<li>Calcitonin is the <span class=\"customMeta\" data-dictid=\"19ae68448b16927772016d48bd7fc3\">tumor marker</span> present</li>\n<li>Cold nodules are seen on the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> scan</li>\n<li>Metastasis can be traced with PET scan</li>\n<li>Visible neck mass, causing dysphagia</li>\n<li><strong>Rx</strong>- Prophylactic thyroidectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reproductive <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> tumors</strong></p>\n<ul>\n<li>Testicular tumors</li>\n<li>Neuroendocrine tumor (Cervix)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Congenital aganglionosis,</li>\n<li>Hirschsprung disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marfanoid habitus</li>\n<li>Medullated corneal nerve fibers</li>\n<li>Mucosal neuromas</li>\n<li>Megacolon and Multiple diverticulae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occasionally with</p>\n<ul>\n<li>Renal tumor</li>\n<li>Adrenal tumor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are typically done in breast conservation surgery? Wide local excision Axillary node dissection Frozen section during surgery Post-operative radiotherapy (optional)", "options": [{"label": "A", "text": "1, 2, 3", "correct": true}, {"label": "B", "text": "1, 3, 4", "correct": false}, {"label": "C", "text": "1, 2", "correct": false}, {"label": "D", "text": "2, 3", "correct": false}], "correct_answer": "A. 1, 2, 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-trimester Pregnancy</li>\n<li>Multicentric Disease</li>\n<li><strong>Diffuse Suspicious microcalcifications on mammogram</strong></li>\n<li>Extensive DCIS</li>\n<li>Inflammatory Breast Cancer</li>\n<li>Tumors for which Clear Margins are Unobtainable with Lumpectomy</li>\n<li>Homozygous for <span class=\"customMeta\" data-dictid=\"17b09d09f81692777182bb007591a1\">ATM</span> Mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Prior Radiation Therapy to the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">Chest Wall</span> or Breast</strong></li>\n<li>Active <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> Tissue Disease Involving the Skin (e.g., Scleroderma)</li>\n<li>Extensive Positive <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">Pathological</span> Margins</li>\n<li><strong>Large Tumor Size Relative to Breast Size or Tumors Greater Than 5 cm</strong></li>\n<li>Known or Suspected Li-Fraumeni Syndrome (p53 Mutation)</li>\n<li><strong>Known or Suspected Genetic <span class=\"customMeta\" data-dictid=\"6fc754288b1692777196b7664d3a9a\">Predisposition</span> to Breast Cancer (e.g., BRCA1, BRCA2)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Extra mammary Paget’s disease is commonly seen in the:", "options": [{"label": "A", "text": "Vulva", "correct": true}, {"label": "B", "text": "Vagina", "correct": false}, {"label": "C", "text": "Uterus", "correct": false}, {"label": "D", "text": "Cervix", "correct": false}], "correct_answer": "A. Vulva", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vulva: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the Van Nuys grading system for ductal carcinoma in situ?", "options": [{"label": "A", "text": "Age of the patient", "correct": false}, {"label": "B", "text": "Size of the tumor", "correct": false}, {"label": "C", "text": "Hormone receptor staining", "correct": true}, {"label": "D", "text": "Comedo-type necrosis", "correct": false}], "correct_answer": "C. Hormone receptor staining", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Hormone &lt;span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\"&gt;receptor&lt;/span&gt; staining:</p>\n<table>\n<thead>\n<tr>\n<td colspan=\"1\" rowspan=\"1\" style=\"vertical-align:bottom\"><strong>Score</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center; vertical-align:bottom\">1</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center; vertical-align:bottom\">2</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center; vertical-align:bottom\">3</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Size</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">≤15 mm</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">16–40</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&gt;40</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Margin</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">≥10 mm</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">1–9</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&lt;1</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Class</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">Grade 1/2 without necrosis</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">Grade 1/2 with necrosis</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">Grade 3</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Age</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&gt;60</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">40–60</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&lt;40</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following locations is the dye injected for Sentinel Lymph Node Biopsy ?", "options": [{"label": "A", "text": "Axilla", "correct": false}, {"label": "B", "text": "Tail of spence", "correct": false}, {"label": "C", "text": "Nipple", "correct": false}, {"label": "D", "text": "Areola", "correct": true}], "correct_answer": "D. Areola", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate portrayal of Paget's disease of the breast?", "options": [{"label": "A", "text": "Eczema of skin of nipple", "correct": true}, {"label": "B", "text": "The most common presentation is bilateral..", "correct": false}, {"label": "C", "text": "Mastitis carcinomatosis", "correct": false}, {"label": "D", "text": "Atrophic scirrhous carcinoma", "correct": false}], "correct_answer": "A. Eczema of skin of nipple", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6oUKASrqKmbBk9kTgqLB1714481840.png"], "explanation": "<p>Correct Option A - Eczema of skin of nipple: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common benign breast tumour :", "options": [{"label": "A", "text": "Fibroadenoma", "correct": true}, {"label": "B", "text": "Fibroadenosis", "correct": false}, {"label": "C", "text": "DCIS", "correct": false}, {"label": "D", "text": "Phyllodes tumour", "correct": false}], "correct_answer": "A. Fibroadenoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the breast triple assessment?", "options": [{"label": "A", "text": "Clinical examination", "correct": false}, {"label": "B", "text": "Axillary sampling", "correct": true}, {"label": "C", "text": "USG", "correct": false}, {"label": "D", "text": "FNAC and biopsy", "correct": false}], "correct_answer": "B. Axillary sampling", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Axillary sampling\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The probable diagnosis based on the below clinical image of the breast is ?", "options": [{"label": "A", "text": "Paget's disease", "correct": false}, {"label": "B", "text": "Mondor's disease", "correct": true}, {"label": "C", "text": "Zuska's disease", "correct": false}, {"label": "D", "text": "Tietze syndrome", "correct": false}], "correct_answer": "B. Mondor's disease", "question_images": ["https://image.prepladder.com/content/fBHa8uGbzUFOzua158LU1714391105.png"], "explanation_images": [], "explanation": "<p>Correct Option B - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not classify as locally advanced breast cancer ?", "options": [{"label": "A", "text": "Tumor less than 4 cm", "correct": true}, {"label": "B", "text": "Inflammatory breast cancer", "correct": false}, {"label": "C", "text": "Chest wall involvement", "correct": false}, {"label": "D", "text": "Skin involvement", "correct": false}], "correct_answer": "A. Tumor less than 4 cm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Tumor less than 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a nodule of the neck presents to the surgery OPD . A Junior resident performs the following method to palpate it . Identify the procedure shown in the video below.", "options": [{"label": "A", "text": "Lahey's method", "correct": true}, {"label": "B", "text": "Crile's method", "correct": false}, {"label": "C", "text": "Kocher's method", "correct": false}, {"label": "D", "text": "Pemberton's method", "correct": false}], "correct_answer": "A. Lahey's method", "question_images": ["https://image.prepladder.com/content/k3RidUkaRu5FfjDdq0rB1714391184.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Lahey's meth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most conspicuous sign of breast cancer ?", "options": [{"label": "A", "text": "Nipple retraction", "correct": false}, {"label": "B", "text": "Peau d’orange", "correct": true}, {"label": "C", "text": "Puckering", "correct": false}, {"label": "D", "text": "Both nipple retraction and puckering", "correct": false}], "correct_answer": "B. Peau d’orange", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UgrX3PWGeGj4vKI31tHT1714388780.png", "https://image.prepladder.com/content/Z7CB5IwxGfm1GKm0s6xq1714388850.png", "https://image.prepladder.com/content/OR9uPbOcSNk2LO0sMFDt1712034754.png", "https://image.prepladder.com/content/qK5v0YeS9lInRjnu6ABy1714388877.png"], "explanation": "<p>Correct Option B - Peau d’orang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image shows methylene blue dye being injected into the peritumoral region . What is this procedure useful for?", "options": [{"label": "A", "text": "Localizing the tumor", "correct": false}, {"label": "B", "text": "Identifying the margins", "correct": false}, {"label": "C", "text": "Sentinel Lymph node biopsy", "correct": true}, {"label": "D", "text": "Identifying metastasis", "correct": false}], "correct_answer": "C. Sentinel Lymph node biopsy", "question_images": ["https://image.prepladder.com/content/2oZhKCq3XAdYPB2RsvMe1714391027.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Sentinel &lt;span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\"&gt;Lymph&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\"&gt;node&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common cause of thyroid storm following thyroidectomy ?", "options": [{"label": "A", "text": "Rough handling of thyroid during surgery", "correct": false}, {"label": "B", "text": "Due to parathyroid gland", "correct": false}, {"label": "C", "text": "Inadequate patient preparation", "correct": true}, {"label": "D", "text": "Infections", "correct": false}], "correct_answer": "C. Inadequate patient preparation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Inadequ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the procedure in which a probe is inserted into the duct from which the discharge is emerging, followed by making a tennis racquet incision and dissecting the flap to reach the duct, and finally excising the duct?", "options": [{"label": "A", "text": "Macrodochectomy", "correct": false}, {"label": "B", "text": "Microdochectomy", "correct": true}, {"label": "C", "text": "Cone excision", "correct": false}, {"label": "D", "text": "Wide excision of the lactiferous duct", "correct": false}], "correct_answer": "B. Microdochectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Microdoch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents with a breast abscess . Under antibiotic cover, an aspiration was attempted which failed to reveal any aspirate . What is the next step in management?", "options": [{"label": "A", "text": "Incision and Drainage", "correct": false}, {"label": "B", "text": "Continue antibiotics only", "correct": false}, {"label": "C", "text": "Incision and drainage + Antibiotics", "correct": true}, {"label": "D", "text": "Stop antibiotics as no aspirate was collected", "correct": false}], "correct_answer": "C. Incision and drainage + Antibiotics", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Da8xaHokdxNhHmPCIN7B1714388588.png"], "explanation": "<p>Correct Option C - Incision and &lt;span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\"&gt;drainage&lt;/span&gt; + A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common surgical approach for a retrosternal goiter ?", "options": [{"label": "A", "text": "Mediastinal incision", "correct": false}, {"label": "B", "text": "Subxiphoid incision", "correct": false}, {"label": "C", "text": "Transaxillary incision", "correct": false}, {"label": "D", "text": "Cervical incision", "correct": true}], "correct_answer": "D. Cervical incision", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common surgical approach for a retrosternal goiter ?", "options": [{"label": "A", "text": "Mediastinal incision", "correct": false}, {"label": "B", "text": "Subxiphoid incision", "correct": false}, {"label": "C", "text": "Transaxillary incision", "correct": false}, {"label": "D", "text": "Cervical incision", "correct": true}], "correct_answer": "D. Cervical incision", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug used for estrogen dependant breast cancer ?", "options": [{"label": "A", "text": "Lapatinib", "correct": false}, {"label": "B", "text": "Sunitinib", "correct": false}, {"label": "C", "text": "Tamoxifen", "correct": true}, {"label": "D", "text": "Adriamycin", "correct": false}], "correct_answer": "C. Tamoxifen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Parathyroid gland post-surgery is commonly transferred to?", "options": [{"label": "A", "text": "Triceps", "correct": false}, {"label": "B", "text": "Biceps", "correct": false}, {"label": "C", "text": "Sartorius", "correct": false}, {"label": "D", "text": "Brachioradialis", "correct": true}], "correct_answer": "D. Brachioradialis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Brach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Paget's disease of the nipple is:", "options": [{"label": "A", "text": "Infection", "correct": false}, {"label": "B", "text": "Dermatitis", "correct": false}, {"label": "C", "text": "Neoplasia", "correct": true}, {"label": "D", "text": "Hypopigmentation", "correct": false}], "correct_answer": "C. Neoplasia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neoplasia: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective method for diagnosing pheochromocytoma among the following options?", "options": [{"label": "A", "text": "24-hour urinary Vanillylmandelic acid", "correct": false}, {"label": "B", "text": "24-hour urinary Fractionated Metanephrine", "correct": true}, {"label": "C", "text": "24-hour Urinary Hydroxy indole acetic acid", "correct": false}, {"label": "D", "text": "24-hour Urinary Hydroxy tryptamine", "correct": false}], "correct_answer": "B. 24-hour urinary Fractionated Metanephrine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 24-hour &lt;span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\"&gt;urinary&lt;/span&gt; Fractionated Metaneph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective treatment for a 27-year-old woman who is 26 weeks pregnant and has been diagnosed with papillary carcinoma of the thyroid?", "options": [{"label": "A", "text": "Thyroid ablation using radioactive Iodine", "correct": false}, {"label": "B", "text": "Total thyroidectomy", "correct": true}, {"label": "C", "text": "Observation", "correct": false}, {"label": "D", "text": "Hemi-thyroidectomy", "correct": false}], "correct_answer": "B. Total thyroidectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Total th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents with breast enlargement and tenderness without a substance abuse history . Examination shows visibly enlarged breasts with palpable tissue beneath the nipples . What is the least likely cause of his gynecomastia?", "options": [{"label": "A", "text": "Klinefelter syndrome", "correct": false}, {"label": "B", "text": "Liver cirrhosis", "correct": false}, {"label": "C", "text": "Hypothyroidism", "correct": false}, {"label": "D", "text": "Prostate cancer", "correct": true}], "correct_answer": "D. Prostate cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Choose from the following the typical trigger for thyroid storm following thyroidectomy :", "options": [{"label": "A", "text": "Rough handling of thyroid during surgery", "correct": false}, {"label": "B", "text": "Due to parathyroid gland", "correct": false}, {"label": "C", "text": "Inadequate patient preparation", "correct": true}, {"label": "D", "text": "Infections", "correct": false}], "correct_answer": "C. Inadequate patient preparation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Inadequ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the signs and symptoms caused by hormones released from tumor tissue, which cannot be explained by the tumor's anatomical distribution?", "options": [{"label": "A", "text": "Pretumor syndrome", "correct": false}, {"label": "B", "text": "Paraneoplastic syndrome", "correct": true}, {"label": "C", "text": "Paratumour syndrome", "correct": false}, {"label": "D", "text": "Autocrine phenomenon", "correct": false}], "correct_answer": "B. Paraneoplastic syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 96 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 12-year-old child presents with congenital sensorineural hearing loss, recurrent episodes of vertigo, and a palpable thyroid gland. The child's mother has a similar history. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Alport syndrome", "correct": false}, {"label": "B", "text": "Pendred syndrome", "correct": true}, {"label": "C", "text": "Usher syndrome", "correct": false}, {"label": "D", "text": "Perrault syndrome", "correct": false}], "correct_answer": "B. Pendred syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8neMHZSKj6yx9MCThkjx1744878490.mp3", "video": ""}, {"text": "Identify the below technique used during the examination of the thyroid gland.", "options": [{"label": "A", "text": "Kocher's method", "correct": false}, {"label": "B", "text": "Lahey’s method", "correct": true}, {"label": "C", "text": "Crile’s method", "correct": false}, {"label": "D", "text": "Pizillo’s method", "correct": false}], "correct_answer": "B. Lahey’s method", "question_images": ["https://image.prepladder.com/content/oQQMZTJRHhOND0VGQVyd1739887612.png"], "explanation_images": ["https://image.prepladder.com/content/ruozoaq9ucn2lkkczOEN1739887693.png", "https://image.prepladder.com/content/M7YorqubygmTW08OUcd81739887758.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MXIHzbL5BE2UgLAF5Tk01744878295.mp3", "video": ""}, {"text": "A 44-year-old woman presents with a solitary thyroid swelling. On examination, a 3 cm non-tender thyroid nodule is noted, and her thyroid function tests are normal. What is the next step in the investigation of this thyroid swelling?", "options": [{"label": "A", "text": "Fine Needle Aspiration Cytology", "correct": false}, {"label": "B", "text": "USG of thyroid", "correct": true}, {"label": "C", "text": "Core biopsy", "correct": false}, {"label": "D", "text": "CT neck", "correct": false}], "correct_answer": "B. USG of thyroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8g6WjaeLnynEqMPwK8C41739886916.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benign nodule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>For a <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> nodule</strong>: <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> - Recurrence<strong> -</strong> Hemithyroidectomy.</li>\n<li><strong>For a solid nodule:</strong> <span class=\"customMeta\" data-dictid=\"22d375381416927772009663d54998\">Thyroxine</span> - Persistent compressive symptoms -Hemithyroidectomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Near / Total thyroidectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QrW6g0Z9flU5g4uFfUY41744873312.mp3", "video": ""}, {"text": "Which of the following conditions is a contraindication for radioactive iodine therapy?", "options": [{"label": "A", "text": "Medullary thyroid carcinoma", "correct": true}, {"label": "B", "text": "Papillary thyroid carcinoma", "correct": false}, {"label": "C", "text": "Hurthle cell carcinoma", "correct": false}, {"label": "D", "text": "Tumor size &amp;gt; 2cm + distant metastasis", "correct": false}], "correct_answer": "A. Medullary thyroid carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:698px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It arises from the parafollicular 'C' cells, which are derived from the <span class=\"customMeta\" data-dictid=\"b9ad79d8c41692777201a188af477a\">ultimobranchial</span> body (neural crest).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secrete </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High levels of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"cc4b4052651692777183edb479e5b9\">calcitonin</span> and <span class=\"customMeta\" data-dictid=\"11b3cfa9a31692777183e48dccbc39\">carcinoembryonic</span> antigen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 types:</p>\n<ul>\n<li>a) Sporadic: 80% cases, seen in 5th-6th decade, U/L</li>\n<li>b) Familial: 20% cases, associated with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2A/2B</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mutation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RET <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> mutation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thyroid <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> often with <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of neck <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, diarrhea, flushing, hypertension, pheochromocytomas and mucosal neuromas when associated with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> II syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FNAC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tumor <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to thyroid:<strong> </strong>total <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">thyroidectomy</span> + central neck dissection</li>\n<li>+ <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> MRND (If the tumor size is &gt; 1</li>\n<li>cm)</li>\n<li>± <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> MRND (If any <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> is positive despite the extensive surgery).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancers</li>\n</ul>\n<p>E.g., <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Option B)</strong></p>\n<p>Follicular <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</p>\n<p>Hurthle cell carcinoma<strong> (Option C)</strong></p>\n<ul>\n<li>Tumor size &gt; 2 cm <strong>(Option D)</strong></li>\n<li>One or more risk factors</li>\n<li>Obvious <span class=\"customMeta\" data-dictid=\"756a84577116927771871853f8642e\">extrathyroidal</span> extension</li>\n<li>&gt; 45 years of age</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> and distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Poorly differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancers</li>\n</ul>\n<p>E.g., <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">Medullary</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</p>\n<p>Anaplastic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</p>\n<ul>\n<li>Pregnancy &amp; <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">Breastfeeding</span> <strong>(Absolute contraindications)</strong></li>\n<li>Vomiting &amp; <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> (Relative contraindications)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dGmv1zqu5I95mWq8Dvnz1744877778.mp3", "video": ""}, {"text": "A 27-year-old female presents with symptoms of weight loss, palpitations and eye protrusion. Lab tests reveal ￬ TSH and ￪ T3, T4 values. What is the most likely diagnosis and the primary target of this condition?", "options": [{"label": "A", "text": "Toxic multinodular goiter,TSH receptor", "correct": false}, {"label": "B", "text": "Graves disease, TSH receptor", "correct": true}, {"label": "C", "text": "Hashimoto's Thyroiditis, TPO", "correct": false}, {"label": "D", "text": "Subacute Thyroiditis, Thyroglobulin", "correct": false}], "correct_answer": "B. Graves disease, TSH receptor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Tm9EQRudFeN4BFn28mjS1739887055.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3Lj5ps1k8EMRdAuBMKwQ1744874366.mp3", "video": ""}, {"text": "A 50-year-old woman with Graves disease has been receiving medical management for 6 months but continues to have significant symptoms and persistent ophthalmopathy. The goitre remains large. Considering her ongoing symptoms, what is the most appropriate next step in her treatment?", "options": [{"label": "A", "text": "Thyroidectomy", "correct": true}, {"label": "B", "text": "Radioactive iodine ablation", "correct": false}, {"label": "C", "text": "Antithyroid medications and beta-blockers.", "correct": false}, {"label": "D", "text": "External beam radiotherapy", "correct": false}], "correct_answer": "A. Thyroidectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:483px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stellwag's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced blink rate or incomplete blinking.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dalrymple’s Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visible upper <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> with lid retraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Von Graefe's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lid <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> on down gaze</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joffroy's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absence of Forehead wrinkling on Upgaze</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moebius Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of Accommodation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oDHnLchH8skKAFHVFcJa1744874681.mp3", "video": ""}, {"text": "A 45-year-old man presents with neck pain, fever, and fatigue. His physical examination shows a tender, swollen thyroid gland. Lab reports revealed elevated inflammatory markers and low radioactive iodine uptake, and he is HLA B35 positive. What is the most appropriate initial treatment step for this patient?", "options": [{"label": "A", "text": "NSAIDs", "correct": true}, {"label": "B", "text": "Start Levothyroxine and continue throughout", "correct": false}, {"label": "C", "text": "Start antithyroid drugs", "correct": false}, {"label": "D", "text": "Thyroidectomy", "correct": false}], "correct_answer": "A. NSAIDs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z6dj6t8CHxeyAWpDmP8S1744875184.mp3", "video": ""}, {"text": "A 40-year-old woman with a known history of Graves' disease presents with signs of thyroid storm i.e., fever, delirium, tachycardia, and restlessness. In addition to beta-blockers and antithyroid drugs, she is started on glucocorticoids. What is the primary rationale for administering glucocorticoids in the management of thyroid storm?", "options": [{"label": "A", "text": "To block the conversion of T4 to T3", "correct": true}, {"label": "B", "text": "To suppress the synthesis of thyroid hormones", "correct": false}, {"label": "C", "text": "To reduce the effects of catecholamines", "correct": false}, {"label": "D", "text": "To block the release of T4 and T3", "correct": false}], "correct_answer": "A. To block the conversion of T4 to T3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> storm</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oxygen supplementation</li>\n<li>IV fluids (with continuous monitoring with central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> catheter)</li>\n<li>Stop IV fluids/blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> in case of <span class=\"customMeta\" data-dictid=\"d120a30dab1692777184bdcc21c20d\">CHF</span> or arrhythmias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Propylthiouracil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>This is the drug of choice</strong></li>\n<li>It acts by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> &amp; inhibiting <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> conversion of T4 to T3<strong> (Option B)</strong></li>\n<li>ROA: NG Tube, rectal route</li>\n<li><strong>Methimazole</strong> can be used as an alternative option instead of Propylthiouracil</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Propranolol</strong> is commonly used</li>\n<li>It reduces the heart rate &amp; the effects of catecholamines <strong>(Option C)</strong></li>\n<li><strong>Esmolol</strong> is used in case of <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> as <span class=\"customMeta\" data-dictid=\"082f7143eb1692777196df69a3b6cb\">Propranolol</span> should be avoided in such conditions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hydrocortisone</strong> is preferred</li>\n<li>It acts by <strong>inhibiting the conversion of T4 to T3</strong></li>\n<li>It helps in preventing <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> crisis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lugol solution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It <strong>blocks the release of T3 and T4 </strong>and to reduce the <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <strong>(Option D)</strong></li>\n<li>It is also used preoperatively to prevent <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> storms by inducing the Wolff-Chaikoff effect.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cholestyramine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is used to help <span class=\"customMeta\" data-dictid=\"08af02471516927771988150ca6e24\">sequester</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chlorpromazine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to induce sedation.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasmapheresis, <span class=\"customMeta\" data-dictid=\"e7626b047e169277718484971217b8\">charcoal</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> perfusion, or exchange transfusion</strong> are reserved for <strong>refractory cases</strong> that do not respond to standard treatment within 24 to 48 hours.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DAMZZCn6DavayzIFK8az1744878831.mp3", "video": ""}, {"text": "A 20-year-old male presents with a midline neck mass that has been present since childhood and gradually increased in size. On examination, the mass moves upwards with a tongue protrusion. An ultrasound confirms a cystic lesion in the midline of the neck. Given the clinical presentation and imaging findings, which statements are true?", "options": [{"label": "A", "text": "High risk of developing squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Removal of the cyst along with the tract and part of the hyoid bone is done", "correct": true}, {"label": "C", "text": "Most commonly seen in the suprahyoid region", "correct": false}, {"label": "D", "text": "Incision and Drainage are the preferred management", "correct": false}], "correct_answer": "B. Removal of the cyst along with the tract and part of the hyoid bone is done", "question_images": ["https://image.prepladder.com/content/j7OXwIPetEQAWbX5trGW1739885588.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LCxJYBCjIKj5DOdKdjCD1744872217.mp3", "video": ""}, {"text": "A 64-year-old man with multinodular goitre is being treated with a large dose of iodine. Subsequently, his thyroid function tests show significantly elevated TSH and low free T4 levels, but he is asymptomatic. What is the most likely finding?", "options": [{"label": "A", "text": "Jod- Basedow effect", "correct": false}, {"label": "B", "text": "Wolff-Chaikoff effect", "correct": true}, {"label": "C", "text": "Amiodarone- induced thyrotoxicosis", "correct": false}, {"label": "D", "text": "Thyroid storm", "correct": false}], "correct_answer": "B. Wolff-Chaikoff effect", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TTYmqUlBOk8ljcTBqsK91744878678.mp3", "video": ""}, {"text": "A 31-year-old female with Graves' disease who underwent total thyroidectomy now presents with hoarseness of voice and stridor due to recurrent laryngeal nerve injury. What is the most common site of injury to the recurrent laryngeal nerve?", "options": [{"label": "A", "text": "Through the carotid sheath", "correct": false}, {"label": "B", "text": "At the level of the zuckerkandl tubercle", "correct": false}, {"label": "C", "text": "At the level of the cricothyroid muscle", "correct": false}, {"label": "D", "text": "Near the inferior thyroid artery", "correct": true}], "correct_answer": "D. Near the inferior thyroid artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SOAufu6vSasHhSjRdPt31744878170.mp3", "video": ""}, {"text": "A 60-year-old man presents with worsening shortness of breath and difficulty swallowing. On physical examination, a large, firm, and non-tender neck swelling is noted. The lower limit of the swelling cannot be palpated, and raising his arms above his head results in the finding shown in the image. Given these clinical findings, which of the following is the Investigation of choice?", "options": [{"label": "A", "text": "Ultrasound of the Neck", "correct": false}, {"label": "B", "text": "CT Scan of the Neck and Chest", "correct": true}, {"label": "C", "text": "MRI of the Neck", "correct": false}, {"label": "D", "text": "Radioactive Iodine Uptake Test", "correct": false}], "correct_answer": "B. CT Scan of the Neck and Chest", "question_images": ["https://image.prepladder.com/content/2Vi6tbnphbsM53Q3nRso1739887467.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QrSBZf2lgPQkeASCj5Xo1744876502.mp3", "video": ""}, {"text": "A 60-year-old woman with a large multinodular goitre is scheduled for a total thyroidectomy. To prepare her for the surgery and reduce the risk of complications, her endocrinologist prescribed Lugol's iodine. Which of the following statements are true regarding Lugol's iodine? It is used to reduce thyroid vascularity before thyroid surgery It works by inhibiting the synthesis of thyroid hormones in the thyroid gland It increases the uptake of radioactive iodine It is not commonly indicated in the management of toxic multinodular goiter It is not indicated in case of a thyroid storm.", "options": [{"label": "A", "text": "1,2,5", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "3,4,5", "correct": false}, {"label": "D", "text": "1,2,4", "correct": true}], "correct_answer": "D. 1,2,4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SQJ7batxfCx5SBZHCZ0I1744875841.mp3", "video": ""}, {"text": "A 55-year-old woman presents with an enlarging, hard, and fixed thyroid mass, neck discomfort, and difficulty swallowing. On examination, the thyroid gland feels rock-hard with no tenderness. Ultrasound of the thyroid shows extensive fibrosis. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Riedel’s Thyroiditis", "correct": true}, {"label": "B", "text": "Hashimoto’s Thyroiditis", "correct": false}, {"label": "C", "text": "De Quervain’s Thyroiditis", "correct": false}, {"label": "D", "text": "Silent Thyroiditis", "correct": false}], "correct_answer": "A. Riedel’s Thyroiditis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:732px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hashimoto Thyroiditis</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>De Quervain’s </strong></p>\n<p><strong>Thyroiditis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Riedel’s</strong></p>\n<p><strong>Thyroiditis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Also Known As</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Struma Lymphomatosa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Viral Thyroiditis,</li>\n<li>Granulomatous Thyroiditis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrosing Thyroiditis</p>\n<p>Riedel struma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune</p>\n<ul>\n<li>Anti-TPO antibodies</li>\n<li>HLA-B8/DR3</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Viral infection,</p>\n<ul>\n<li>Granulomatous inflammation</li>\n<li>HLA-B35</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune or a part of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> fibrosing disorder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">Hyperthyroidism</span> followed by Prolonged Hypothyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brief <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">Hyperthyroidism</span> followed by <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">Hypothyroidism</span> and returns to <span class=\"customMeta\" data-dictid=\"a0cba39e531692777187f51570565d\">Euthyroid</span> state in 3 - 4 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> and hypoparathyroidism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Levothyroxine</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">thyroidectomy</span> if <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> is suspected.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NSAIDs (first-line)</li>\n<li>Steroids (if NSAIDs are ineffective)</li>\n<li>&gt;90% <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Corticosteroids and tamoxifen</strong></li>\n<li>Life long management with</li>\n</ul>\n<ul>\n<li>Levothyroxine</li>\n<li>Calcium &amp; <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> in case of hypoparathyroidism</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vF9LGjFssKLHTclnd78L1744874816.mp3", "video": ""}, {"text": "A 30-year-old pregnant woman in her first trimester is diagnosed with Graves disease. What is the most appropriate first-line treatment for her condition?", "options": [{"label": "A", "text": "Propylthiouracil", "correct": true}, {"label": "B", "text": "Methimazole", "correct": false}, {"label": "C", "text": "Levothyroxine", "correct": false}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "A. Propylthiouracil", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical consideration</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Propylthiouracil </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pregnant women (first trimester), children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Safe in the first <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> and for children; risk of liver toxicity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methimazole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults, pregnant women (second and third trimesters)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher efficacy; not used in the first <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> due to <span class=\"customMeta\" data-dictid=\"8e016cf2891692777200f428d4b4db\">teratogenic</span> effects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carbimazole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults, children (in some regions)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Converts to methimazole.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta Blockers (e.g., Propranolol)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Manages <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> symptoms; used as adjunctive therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5OuI8uNJG6ThUKo5gbIt1744874554.mp3", "video": ""}, {"text": "A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where Tsh level is 27.3mU/L, T3 is 1.24 ng/ml, and T4 is 4.87 microgram/ml. Which of the following manifestations is true regarding the condition?", "options": [{"label": "A", "text": "Heat intolerance", "correct": false}, {"label": "B", "text": "Tachycardia", "correct": false}, {"label": "C", "text": "Diarrhea", "correct": false}, {"label": "D", "text": "Weight gain", "correct": true}], "correct_answer": "D. Weight gain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperthyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight gain, puffiness, dry skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased appetite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased appetite</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bradycardia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cold intolerance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heat intolerance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constipation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Menorrhagia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amenorrhea, infertility</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiomegaly, <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiovascular complications such as atrial fibrillation, cardiomyopathy, congestive heart failure</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Altered mental status, coma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VhOpdpBsZ3rhPF42tY9B1744874012.mp3", "video": ""}, {"text": "A 36-year-old woman presents with a solid, hypoechoic thyroid nodule. She undergoes Fine Needle Aspiration Cytology (FNAC), which confirms the nodule is benign. What is the most appropriate Bethesda classification and its management for this benign thyroid nodule?", "options": [{"label": "A", "text": "Bethesda I; Repeat FNA", "correct": false}, {"label": "B", "text": "Bethesda II; Clinical and sonographic follow-up", "correct": true}, {"label": "C", "text": "Bethesda III; Near total thyroidectomy", "correct": false}, {"label": "D", "text": "Bethesda VI; Repeat FNA, molecular testing or lobectomy", "correct": false}], "correct_answer": "B. Bethesda II; Clinical and sonographic follow-up", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bethesda I</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-diagnostic or unsatisfactory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeat FNA with <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> guidance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bethesda II</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical and <span class=\"customMeta\" data-dictid=\"250ea353d2169277719853a4313f1b\">sonographic</span> follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bethesda III</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atypia of undermined significance or <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> of undermined significance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeat FNA, molecular testing or lobectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bethesda IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicion for <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> neoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Molecular testing and lobectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bethesda V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicion for malignancy</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Near total <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">thyroidectomy</span> or lobectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bethesda VI</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignancy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NXgr7ierIyLcWVF1u2R91744873508.mp3", "video": ""}, {"text": "A 65-year-old woman presents with a thyroid mass and normal thyroid function tests. Fine Needle Aspiration Cytology (FNAC) is planned to evaluate the mass. Which of the following conditions is FNAC effective in diagnosing?", "options": [{"label": "A", "text": "Follicular Neoplasm", "correct": false}, {"label": "B", "text": "Riedel’s Thyroiditis", "correct": false}, {"label": "C", "text": "Thyroid Lymphoma", "correct": false}, {"label": "D", "text": "Solitary Thyroid Nodule", "correct": true}], "correct_answer": "D. Solitary Thyroid Nodule", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:252px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non diagnostic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 1c</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> cystic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non neoplastic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicion of malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oSX9av9zlcMiKO7VHR9y1744873113.mp3", "video": ""}, {"text": "A 45-year-old patient with a history of multinodular goitre is being considered for thyroid surgery. The surgical team decides to perform a procedure that removes the majority of the thyroid gland, leaving a small amount of tissue in one of the lobes and removing the isthmus. Which of the following best describes this procedure?", "options": [{"label": "A", "text": "Total Thyroidectomy", "correct": false}, {"label": "B", "text": "Lobectomy", "correct": false}, {"label": "C", "text": "Dunhill Procedure", "correct": true}, {"label": "D", "text": "Subtotal Thyroidectomy", "correct": false}], "correct_answer": "C. Dunhill Procedure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JnvT7iw4helSvdol0KiS1739886580.png", "https://image.prepladder.com/content/m3XxKjPrEvQDUOdzBKPV1739886620.png", "https://image.prepladder.com/content/wv6KHpWL7LgmhtCvpci11739886781.png", "https://image.prepladder.com/content/jkhN7Q8OUp8Q4XoIMhTQ1739886656.png", "https://image.prepladder.com/content/IrG6wCzK068GSPPb9VIg1739886810.png", "https://image.prepladder.com/content/gFdSSxD4SN6zJRqOIsWs1739886682.png", "https://image.prepladder.com/content/T88Q80sUi3EKtcf1KyJE1739886839.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Thyroidectomy</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2 × <span class=\"customMeta\" data-dictid=\"8e55f41cc61692777191163ded2004\">Lobectomy</span> + Isthmusectomy</li>\n<li>Requires lifelong <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone replacement therapy.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/JnvT7iw4helSvdol0KiS1739886580.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtotal Thyroidectomy</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2 × <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">Subtotal</span> <span class=\"customMeta\" data-dictid=\"8e55f41cc61692777191163ded2004\">Lobectomy</span> + Isthmusectomy</li>\n<li>Some functions are preserved with <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n<li>Only Indication - MNG in Elderly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/m3XxKjPrEvQDUOdzBKPV1739886620.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/wv6KHpWL7LgmhtCvpci11739886781.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Near-Total Thyroidectomy</strong><strong> (Dunhill Procedure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lobectomy + Isthmusectomy + <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">Subtotal</span> Lobectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/jkhN7Q8OUp8Q4XoIMhTQ1739886656.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/IrG6wCzK068GSPPb9VIg1739886810.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lobectomy</strong> (Hemithyroidectomy)</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of one <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> + Isthmus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/gFdSSxD4SN6zJRqOIsWs1739886682.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/T88Q80sUi3EKtcf1KyJE1739886839.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BfZ8Z8x5MNcE5E6cYsSL1744872872.mp3", "video": ""}, {"text": "Match the following Thyroid scan images with respective conditions: 1. A. Graves Disease 2. B. Cold nodule 3. C. Hot Nodule 4. D. Toxic Multinodular Goiter", "options": [{"label": "A", "text": "1-C, 2-A, 3-D, 4-B", "correct": true}, {"label": "B", "text": "1-A, 2-C, 3-B, 4-D", "correct": false}, {"label": "C", "text": "1-B, 2-D, 3-A, 4-C", "correct": false}, {"label": "D", "text": "1-C, 2-D, 3-A, 4-B", "correct": false}], "correct_answer": "A. 1-C, 2-A, 3-D, 4-B", "question_images": ["https://image.prepladder.com/content/s26bNkYtSuEXdsoqtyDZ1739885738.png", "https://image.prepladder.com/content/oORv80g3YEMWDXjGRcLJ1739885799.png", "https://image.prepladder.com/content/PjrVwdJHjXWdzFvlGpZN1739885861.png", "https://image.prepladder.com/content/Dv3YT1UMVHlibBY5d80m1739885921.png"], "explanation_images": ["https://image.prepladder.com/content/NiBYNOxhGMro2ZxS5VM21739886052.png", "https://image.prepladder.com/content/iLsO9NUWk0hrNVTPQAdU1739886201.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Thyroid: </strong>Uniform uptake</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" custommeta\"=\"\" data-author=\"Ashish Mishra Muhammad Zohaib Kadir Has University Naved Muhammad Farooq Syed Muhammad Hadi M Jah\" data-dictid=\"799202e6fe16927772009a1501b0a8\" data-hash=\"\" data-license=\"CC0\" data-source=\"(PDF) A Rare and Challenging Case of Neck Infection - &lt;span class=\"/>Thyroid Abscess (researchgate.net)\" data-tags=\"\" height=\"467\" src=\"https://image.prepladder.com/content/O2U0buqGqNBvlzalPqhY1739885980.png\" width=\"500\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hot Nodules: </strong></p>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in specific areas</li>\n<li>Often <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> and indicate hyperfunctioning tissue.</li>\n<li>Risk of Malignancy: 1-3%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Ming-Hsun Wu, Kuen-Yuan Chen, Koung-Yi Liaw, Tien-Shan Huang\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Radionuclide-thyroid-scintigraphy-shows-a-focal-hot-nodule-in-the-inferior-portion-of-the_fig2_7300335\" data-tags=\"\" height=\"479\" src=\"https://image.prepladder.com/content/NiBYNOxhGMro2ZxS5VM21739886052.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cold Nodules</strong>:</p>\n<ul>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in specific areas</li>\n<li>Risk of Malignancy: 17-20%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" custommeta\"=\"\" data-author=\"Mads Ryø Jochumsen, Peter Iversen, Anne Kirstine Arveschoug \" data-dictid=\"031a38f17a16927772036476ede2ae\" data-hash=\"\" data-license=\"CC BY-NC-ND 3.0\" data-source=\"(PDF) &lt;span class=\"/>Follicular <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer avid on C-11 Methionine PET/CT (researchgate.net)\" data-tags=\"\" height=\"401\" src=\"https://image.prepladder.com/content/sWyYAgv6dgW7vjvPg0hn1739886102.png\" width=\"500\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grave’s Disease: </strong>Increased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> throughout the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland, showing heightened overall activity.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" custommeta\"=\"\" data-author=\"Z. Meng, Guizhi Zhang, Haoran Sun, Jian Tan, Chunshun Yu, W. Tian, Weidong Li, Zhiqiang Yang, Mei Zhu, Qing He, Yujie Zhang, Shugao Han\" data-dictid=\"799202e6fe16927772009a1501b0a8\" data-hash=\"\" data-license=\"Open access\" data-source=\"Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, &lt;span class=\"/>thyroid <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> uptake, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> scintigraphy and serum parameters. | Semantic Scholar\" data-tags=\"\" height=\"456\" src=\"https://image.prepladder.com/content/hntCPiyD2FNDkoOPSkrp1739886151.png\" width=\"500\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxic <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">Multinodular</span> Goiter:</strong></p>\n<ul>\n<li>Multiple areas of varying uptake</li>\n<li>Some nodules might show increased activity (Hot Nodules)</li>\n<li>Some might show decreased activity (Cold Nodules)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Goel A, Niknejad M, Vadera S, Mohammad Taghi Niknejad\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/multinodular-goitre\" data-tags=\"\" height=\"425\" src=\"https://image.prepladder.com/content/iLsO9NUWk0hrNVTPQAdU1739886201.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroiditis (Inflammation of the Thyroid): </strong>Decreased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> throughout the areas of <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> due to <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> destruction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" custommeta\"=\"\" data-author=\"Sachin j, Ravindra Shukla, Abhishek Anil, Aswini Saravanan\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Thyroid scan showing thyroiditis. The arrow shows decreased &lt;span class=\"/>uptake of... | Download Scientific Diagram (researchgate.net)\" data-tags=\"\" height=\"592\" src=\"https://image.prepladder.com/content/WT2Ad46HZd1atLFReMd11739886245.png\" width=\"500\" /&gt;</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jpTBte50HJDPK4ayT0oM1744872661.mp3", "video": ""}, {"text": "A 45-year-old woman with differentiated thyroid cancer has undergone a total thyroidectomy. To target any residual thyroid tissue or cancer cells, she is scheduled for radioactive iodine ablation therapy. Which of the following isotopes of iodine is used for this therapeutic procedure?", "options": [{"label": "A", "text": "Iodine-123 (I-123)", "correct": false}, {"label": "B", "text": "Iodine-125 (I-125)", "correct": false}, {"label": "C", "text": "Iodine-131 (I-131)", "correct": true}, {"label": "D", "text": "Iodine-132 (I-132)", "correct": false}], "correct_answer": "C. Iodine-131 (I-131)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:747px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ISOTOPES</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ROUTE OF ADMINISTRATION</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HALF-LIFE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TYPES OF RAYS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>USE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I-123</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> purposes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I-124</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PET scan in <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I-125 </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic purposes and, in some cases, for brachytherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I-131</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>𝜷 and 𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radioactive <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I-132 </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.3 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in research</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tc-99 scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Technetium is better at identifying non-functioning secondaries.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/f2aV733czzKVPivs49z21744872397.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 30-year-old patient presents with hypertension, sweating, and frequent headaches. Imaging reveals a thyroid nodule, and tests show elevated serum calcitonin. The family history includes similar early-onset cases. What condition is most likely associated with these findings?", "options": [{"label": "A", "text": "MEN 1", "correct": false}, {"label": "B", "text": "MEN 2A", "correct": true}, {"label": "C", "text": "Cowden syndrome", "correct": false}, {"label": "D", "text": "Familial medullary thyroid carcinoma", "correct": false}], "correct_answer": "B. MEN 2A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:785px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Mutation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (MTC)</strong></li>\n<li>Pheochromocytoma</li>\n<li>Primary Hyperparathyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RET</strong> <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> gain of function</p>\n<p>- elevated tyrosine kinase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 2B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (MTC) (more aggressive</strong>)</li>\n<li>Pheochromocytoma</li>\n<li>Mucosal Neuromas</li>\n<li>Marfanoid Habitus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RET</strong> <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> gain of function</p>\n<p>- elevated tyrosine kinase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Familial <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">Medullary</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (FMTC) </strong><strong>(Option D</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (MTC) only</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RET</strong> <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> gain of function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cowden Syndrome </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thyroid <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (often follicular)</strong></li>\n<li>Benign Tumors (e.g., skin lesions)</li>\n<li>Increased risk of breast and endometrial cancers.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor <span class=\"customMeta\" data-dictid=\"92427347f51692777199a762a91d21\">suppressor</span> <strong>PTEN</strong> gene</p>\n<p>Loss of function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Werner syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Follicular/ Papillary/Anaplastic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Carcinoma</li>\n<li>Premature aging</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WRN</strong> gene loss of function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gardner Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Papillary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Carcinoma</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> polyps</li>\n<li>Osteomas and soft tissue tumours</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>APC</strong> gene loss of function</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:785px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 1</strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> </strong></li>\n<li><strong>Endocrine tumors </strong>\n<ul>\n<li>Gastrinoma</li>\n<li>Insulinoma / VIPoma</li>\n<li>Pituitary adenoma</li>\n<li>Carcinoid tumor</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEN 1</strong> gene on <strong>Chr</strong>. <strong>11</strong></p>\n<p>Altered menin expression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eS7bCwMLIHk1GEEnRPym1744885379.mp3", "video": ""}, {"text": "A 72-year-old male presents with a rapidly growing thyroid mass accompanied by severe pain and hoarseness of voice. Imaging shows the direct invasion of surrounding structures, including the trachea and oesophagus. The diagnosis of anaplastic thyroid carcinoma is confirmed. In managing this condition, which of the following is not typically included?", "options": [{"label": "A", "text": "Radioactive iodine", "correct": true}, {"label": "B", "text": "Tumor debulking", "correct": false}, {"label": "C", "text": "Doxorubicin", "correct": false}, {"label": "D", "text": "Trametinib", "correct": false}], "correct_answer": "A. Radioactive iodine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LThBrI7HqVo4bwlyFgdK1744887042.mp3", "video": ""}, {"text": "A 45-year-old female recently underwent total thyroidectomy for papillary thyroid carcinoma. Which of the following is not part of her post-surgical management?", "options": [{"label": "A", "text": "Immediately start high-dose thyroxine (T4) to prevent hypothyroidism.", "correct": true}, {"label": "B", "text": "Stop thyroxine (T4) for 6 weeks before a whole-body scan.", "correct": false}, {"label": "C", "text": "Administer recombinant TSH if stopping thyroxine (T4) is intolerable.", "correct": false}, {"label": "D", "text": "PET scan if thyroglobulin rises despite normal neck USG and chest X-ray.", "correct": false}], "correct_answer": "A. Immediately start high-dose thyroxine (T4) to prevent hypothyroidism.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AH2Mnhl8ONRqMkCpiABe1739897158.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sSsEE5aNpEMjChyEfTWA1744886527.mp3", "video": ""}, {"text": "A 45-year-old patient undergoes a total thyroidectomy for a large multinodular goitre. Postoperatively, the patient is monitored for complications. Which of the following is least likely to occur?", "options": [{"label": "A", "text": "Tension Hematoma", "correct": false}, {"label": "B", "text": "Horner's syndrome", "correct": false}, {"label": "C", "text": "RLN Palsy", "correct": false}, {"label": "D", "text": "Hypercalcemia", "correct": true}], "correct_answer": "D. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NkWcwwrxvODeWGqeh8Z21744886152.mp3", "video": ""}, {"text": "A 45-year-old woman with a thyroid pathology is being considered for the procedure shown in the image. Which of the following conditions is a contraindication for this procedure?", "options": [{"label": "A", "text": "Hashimoto's thyroiditis", "correct": true}, {"label": "B", "text": "Benign thyroid nodule 2 cm", "correct": false}, {"label": "C", "text": "T1 Papillary carcinoma", "correct": false}, {"label": "D", "text": "Thyroid adenoma 2.5 cm", "correct": false}], "correct_answer": "A. Hashimoto's thyroiditis", "question_images": ["https://image.prepladder.com/notes/HkMDxJ2BTAPkAvLUuYLl1744894164.png"], "explanation_images": ["https://image.prepladder.com/content/kpq1y1BWpGHPJAQmYiXN1739897881.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KUZYycBjoXEihpv8yale1744889737.mp3", "video": ""}, {"text": "A 55-year-old patient is undergoing a thyroidectomy, and the surgical team uses a specialized retractor to improve exposure and facilitate the operation. Identify the retractor.", "options": [{"label": "A", "text": "Deaver’s retractor", "correct": false}, {"label": "B", "text": "Joll’s retractor", "correct": true}, {"label": "C", "text": "Richardson retractor", "correct": false}, {"label": "D", "text": "Balfour retractor", "correct": false}], "correct_answer": "B. Joll’s retractor", "question_images": ["https://image.prepladder.com/content/TLi3KJ4tuklVrSrZwewn1739897609.png"], "explanation_images": ["https://image.prepladder.com/content/laHSCNjeeY89nxJfRY1F1739897675.png", "https://image.prepladder.com/content/wmBuOYWl2iGQ0yz7dFPO1739897707.png", "https://image.prepladder.com/content/tGsgxi5IZzk8y3seuhVW1739897736.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deaver’s <span class=\"customMeta\" data-dictid=\"63f0da9a1716927771970b98d801d6\">Retractor</span> (Option A):</strong> A General-purpose <span class=\"customMeta\" data-dictid=\"63f0da9a1716927771970b98d801d6\">retractor</span> used in various <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> and <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> surgeries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"194\" src=\"https://image.prepladder.com/content/laHSCNjeeY89nxJfRY1F1739897675.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Richardson <span class=\"customMeta\" data-dictid=\"63f0da9a1716927771970b98d801d6\">Retractor</span> (Option C)</strong>: Commonly used in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgery for <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall retraction.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"369\" src=\"https://image.prepladder.com/content/wmBuOYWl2iGQ0yz7dFPO1739897707.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Volkmann <span class=\"customMeta\" data-dictid=\"63f0da9a1716927771970b98d801d6\">Retractor</span> (Option D):</strong> Often used in <span class=\"customMeta\" data-dictid=\"2a73ca8f1b16927771949cec7c59cc\">orthopaedic</span> surgery, particularly for retracting soft tissues, but not specifically designed for <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> surgery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"105\" src=\"https://image.prepladder.com/content/tGsgxi5IZzk8y3seuhVW1739897736.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sRfooOq1nmsqx4o8dTnq1744889367.mp3", "video": ""}, {"text": "A 60-year-old woman presents with symptoms of hyperthyroidism, including weight loss, palpitations, and tremors. A large thyroid nodule is noted on examination, and laboratory tests reveal elevated thyroid hormones with suppressed thyroid-stimulating hormone (TSH) levels. An ultrasound shows multiple nodules in the thyroid gland. Which of the following management strategies is most appropriate for this patient?", "options": [{"label": "A", "text": "Antithyroid drugs followed by total thyroidectomy", "correct": true}, {"label": "B", "text": "Radioactive iodine therapy", "correct": false}, {"label": "C", "text": "Thyroid hormone replacement therapy", "correct": false}, {"label": "D", "text": "Treat with lugol iodine followed by surgery", "correct": false}], "correct_answer": "A. Antithyroid drugs followed by total thyroidectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rWPYxBUOryEX6ALcgoWq1739897509.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:727px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxic <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">multinodular</span> goitre</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Also known as<strong> </strong><strong>Plummer’s disease, </strong>characterized by multiple overactive <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> nodules causing hyperthyroidism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in females and occurs often after 60 years of age</p>\n<p>Second most common cause of hyperthyroidism</p>\n<p>More prevalent in <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">Iodine</span> deficient region</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> → <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> hormone production → increased hypothalamic <span class=\"customMeta\" data-dictid=\"0242f1c02216927772005cad466d1d\">TRH</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> → persistent <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> → <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> nodules</li>\n</ul>\n<p> </p>\n<ul>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> mutations of <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> occur in long-standing goiters (&gt; 60% of cases) → autonomous <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> of nodules (toxic MNG) → hyperthyroidism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">goiter</span> with multiple <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> nodules</li>\n<li>Symptoms of thyrotoxicosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lab investigations </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↑ T3 and ↓ TSH</li>\n<li>Neck USG - multiple nodules within the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> parenchyma</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"2a445711f21692777197336861a4ac\">radioiodine</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> by multiple hyperfunctioning (hot) nodules\n\t\t\t\t<ul>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> by the rest of the gland</li>\n<li>Hypofunctioning or cold nodules may also be present in the <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">multinodular</span> gland.</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/rWPYxBUOryEX6ALcgoWq1739897509.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antithyroid drugs followed by Total <span class=\"customMeta\" data-dictid=\"2d83e30a3b1692777200b79557c3e1\">Thyroidectomy</span> </strong>are preferred.\n\t\t\t\t<ul>\n<li><strong>Antithyroid drugs</strong> (Carbimazole, Methimazole) are to make the patient <strong>euthyroid </strong>and stabilize the patient before surgery.</li>\n<li><strong>Total thyroidectomy</strong> is to remove the toxic nodules and resolve the underlying problem.</li>\n</ul>\n</li>\n<li><strong>Radioactive <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">Iodine</span> Therapy: Add - “(Iodine-131)” </strong>\n<ul>\n<li>Alternative or adjunctive treatment to destroy overactive <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tissue, especially useful if <strong>surgery is not feasible or desired</strong><strong> </strong><strong>(Option B)</strong></li>\n<li>Given in <strong>high doses as <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> is less compared to graves</strong><strong>.</strong> Hence, it is not preferred before surgery.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1ubLnNMLY9QGhwFnsf281744889244.mp3", "video": ""}, {"text": "A 72-year-old woman with a history of Hashimoto's thyroiditis presents with a rapidly growing thyroid mass, dysphagia, dyspnea, and hoarseness. Biopsy confirms diffuse large B-cell lymphoma. Which of the following is most appropriate for treating this patient?", "options": [{"label": "A", "text": "Surgical resection alone", "correct": false}, {"label": "B", "text": "External beam radiotherapy combined with chemotherapy", "correct": true}, {"label": "C", "text": "Expectant management with hormone replacement", "correct": false}, {"label": "D", "text": "Chemotherapy followed by thyroidectomy", "correct": false}], "correct_answer": "B. External beam radiotherapy combined with chemotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eusXPCfGuO3TcCDxIlB21744888994.mp3", "video": ""}, {"text": "A 62-year-old woman has recently undergone surgery for papillary thyroid carcinoma (PTC). Postoperative pathology reports indicate: Tumour Size: 3.8 cm Extrathyroidal Invasion: Present No lymph node involvement No distant metastases Complete surgical resection Which of the following scoring systems is specifically used to assess the prognosis in the postoperative setting?", "options": [{"label": "A", "text": "AGES Scoring System", "correct": false}, {"label": "B", "text": "AMES Scoring System", "correct": false}, {"label": "C", "text": "MACIS Scoring System", "correct": true}, {"label": "D", "text": "TNM Staging System", "correct": false}], "correct_answer": "C. MACIS Scoring System", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:758px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>AGES System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>AMES System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MACIS</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A</strong>ge</li>\n</ul>\n<ul>\n<li>Histologic <strong>G</strong>rade</li>\n</ul>\n<ul>\n<li><strong>E</strong>xtrathyroidal invasion</li>\n</ul>\n<ul>\n<li><strong>S</strong>ize</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A</strong>ge</li>\n</ul>\n<ul>\n<li><strong>M</strong>etastasis</li>\n</ul>\n<ul>\n<li><strong>E</strong>xtrathyroidal invasion</li>\n</ul>\n<ul>\n<li><strong>S</strong>ize</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>M</strong>etastasis</li>\n</ul>\n<ul>\n<li><strong>A</strong>ge</li>\n</ul>\n<ul>\n<li><strong>C</strong>ompleteness of original <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection</li>\n</ul>\n<ul>\n<li><strong>E</strong>xtrathyroidal invasion</li>\n</ul>\n<ul>\n<li><strong>S</strong>ize</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinomas to assess survival rates and identify high-risk patients.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> index which categorizes patients of differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> into Low and High risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to evaluate the <strong>risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> and survival</strong> after initial treatment.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:509px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Good prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bad Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 1 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 4 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extrathyroidal invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 40 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 40 years</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OjgaUBDAGqPKhoSh7WSg1744888731.mp3", "video": ""}, {"text": "A 40-year-old patient presents with midline neck swelling, persistent diarrhoea, and elevated serum calcitonin. Imaging shows the tumour confined to the thyroid without lymph node involvement. Histopathology reveals amyloid stroma. Which of the following is most appropriate for managing this condition?", "options": [{"label": "A", "text": "Radioactive iodine therapy", "correct": false}, {"label": "B", "text": "Total thyroidectomy with modified radical neck dissection", "correct": false}, {"label": "C", "text": "Tyrosine kinase inhibitors and radiotherapy", "correct": false}, {"label": "D", "text": "Total thyroidectomy with central neck dissection", "correct": true}], "correct_answer": "D. Total thyroidectomy with central neck dissection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/C4I2gpbeDATU5nJg7xie1744887695.mp3", "video": ""}, {"text": "A 45-year-old with midline neck swelling and persistent diarrhoea has an enlarged thyroid gland. The family history includes pheochromocytoma and hyperparathyroidism. The image shows a histopathological examination of the thyroid. Which marker is most valuable for monitoring this condition?", "options": [{"label": "A", "text": "Serum TSH", "correct": false}, {"label": "B", "text": "Serum Calcitonin", "correct": true}, {"label": "C", "text": "Serum Thyroglobulin", "correct": false}, {"label": "D", "text": "Serum PTH", "correct": false}], "correct_answer": "B. Serum Calcitonin", "question_images": ["https://image.prepladder.com/content/im5zvm70zGiSgNQBWFgr1739897217.png"], "explanation_images": ["https://image.prepladder.com/content/kgOAmnsnW5YXsy8MYVWv1739897274.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IN6H8U5VCPiixSYmtsGn1744887199.mp3", "video": ""}, {"text": "A 48-year-old female presents with a midline neck swelling which moves upwards when she swallows. On examination, the swelling is suspected to be related to the thyroid gland. What is the most likely anatomical structure responsible for this movement, and what is the clinical significance of this feature?", "options": [{"label": "A", "text": "Prevertebral fascia - distinguishing thyroid masses from parathyroid masses.", "correct": false}, {"label": "B", "text": "Pretracheal fascia - causes thyroid masses to move with swallowing.", "correct": true}, {"label": "C", "text": "Investing layer of the deep cervical fascia - encloses both the thyroid and trachea.", "correct": false}, {"label": "D", "text": "Superficial fascia - supports the thyroid gland’s position in the neck.", "correct": false}], "correct_answer": "B. Pretracheal fascia - causes thyroid masses to move with swallowing.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/h1Gf6ChZei4uOQqKOLcg1744884346.mp3", "video": ""}, {"text": "A 32 year old female patient presented with complaints of midline swelling in neck without any palpable lymph nodes. FNAC and biopsy revealed the image below. Which of the following should be the management of this condition ?", "options": [{"label": "A", "text": "Thyroidectomy + Removal of enlarged lymph nodes", "correct": false}, {"label": "B", "text": "Thyroidectomy + Removal of enlarged lymph nodes + MRND", "correct": false}, {"label": "C", "text": "MRND", "correct": false}, {"label": "D", "text": "Thyroidectomy", "correct": true}], "correct_answer": "D. Thyroidectomy", "question_images": ["https://image.prepladder.com/content/1kZYuuCs1n7v52SvGyph1739897058.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Yj7iI2rBGVDXnQsdbCvi1744885999.mp3", "video": ""}, {"text": "Which type of incision is typically used for thyroidectomy?", "options": [{"label": "A", "text": "Killian’s incision", "correct": false}, {"label": "B", "text": "Gridiron incision", "correct": false}, {"label": "C", "text": "Lanz crease incision", "correct": false}, {"label": "D", "text": "Kocher’s collar incision", "correct": true}], "correct_answer": "D. Kocher’s collar incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/isv63ed2zHLuwF5SLpRv1739896856.png", "https://image.prepladder.com/content/GikAVwmMuzmPqgJp7GuO1739896923.png", "https://image.prepladder.com/content/9tJndNiWKvGpssXeAVUv1739896977.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FSV0UJS06sj1oo6PrTDs1744885810.mp3", "video": ""}, {"text": "A 56-year-old female patient with a history of long-standing goiter, presented with complaints of sudden, painless increase in the size of swelling of the neck. Biopsy revealed the presence of follicles suggestive of carcinoma. What is the most common site and route of metastasis in this condition?", "options": [{"label": "A", "text": "Lungs, lymphatic", "correct": false}, {"label": "B", "text": "Liver, lymphatic", "correct": false}, {"label": "C", "text": "Bones, hematogenous", "correct": true}, {"label": "D", "text": "Liver, hematogenous", "correct": false}], "correct_answer": "C. Bones, hematogenous", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CYkAOe5oW4S9XFPcSdI61744885669.mp3", "video": ""}, {"text": "A 34-year-old female presents with neck swelling and a history of childhood neck irradiation for Hodgkin’s lymphoma. On examination, a hard mass is found in the neck. FNAC confirms thyroid carcinoma with HPE image given below, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Follicular thyroid carcinoma", "correct": false}, {"label": "B", "text": "Medullary thyroid carcinoma", "correct": false}, {"label": "C", "text": "Anaplastic thyroid carcinoma", "correct": false}, {"label": "D", "text": "Papillary thyroid carcinoma", "correct": true}], "correct_answer": "D. Papillary thyroid carcinoma", "question_images": ["https://image.prepladder.com/content/FnCXzHK4dTV9QHxnGf0V1739896390.png"], "explanation_images": ["https://image.prepladder.com/content/1iWuz5AVt9ITyv93sGse1739896467.png", "https://image.prepladder.com/content/tZRC2xQIlshF4DWc2T3P1739896509.png", "https://image.prepladder.com/content/NwgPSP49KcS4lN2W5tZV1739896563.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:753px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Papillary </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follicular</strong></p>\n<p><strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medullary </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anaplastic</strong></p>\n<p><strong>(Option C)</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Para <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radiation</li>\n<li>Thyroglossal cyst</li>\n<li>Hashimoto’s thyroiditis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iodine deficiency</li>\n<li>Multinodular goitre</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BRAF, RET-PTC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PAX-8,/PPAR-1, PTEN, P-53, RAS</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RET, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>P53</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in the 3rd to 4th decade.</li>\n<li>Midline <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the neck</li>\n<li>Occasionally, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in the 5th to 6th decade.</li>\n<li>A sudden increase in the size of the swelling</li>\n<li>Minimal or no pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Raised calcitonin.</li>\n<li>History of diarrhoea</li>\n<li>Family history of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> or hyperparathyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hematogenous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both and Direct invasion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Optically clear <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (Orphan Annie eye nuclei)</li>\n<li>Dystrophic <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> (Psammoma bodies)</li>\n</ul>\n<p><img alt=\"\" data-author=\"KGH\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Thyroid_papillary_carcinoma_histopathology_%282%29.jpg\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/1iWuz5AVt9ITyv93sGse1739896467.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicles (multiple <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> are seen)</p>\n<br/>\n<br/>\n<br/>\n<br/>\n<img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Follicular_thyroid_cancer#/media/File:Follicular_thyroid_carcinoma_2_--_low_mag.jpg\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/content/tZRC2xQIlshF4DWc2T3P1739896509.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amyloid deposition</p>\n<br/>\n<br/>\n<img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Medullary_thyroid_carcinoma_-_2_-_high_mag.jpg#/media/File:Medullary_thyroid_carcinoma_-_low_mag.jpg\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/content/NwgPSP49KcS4lN2W5tZV1739896563.png\" width=\"500\"/><br/>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly <span class=\"customMeta\" data-dictid=\"d391ed597c1692777195574de6cc11\">pleomorphic</span> cells, <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells, giant cells, often areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and mitotic figures.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XGUJxfpdoP664r4NN6nJ1744885532.mp3", "video": ""}, {"text": "A 58-year-old woman has a 5 cm thyroid tumour with extrathyroidal extension, cervical lymphadenopathy, and no distant metastasis. Based on the TNM staging system, what is the most accurate classification for this patient?", "options": [{"label": "A", "text": "T3b N1 M0", "correct": false}, {"label": "B", "text": "T4 N1 M1", "correct": false}, {"label": "C", "text": "T4 N1 M0", "correct": true}, {"label": "D", "text": "T2 N0 M0", "correct": false}], "correct_answer": "C. T4 N1 M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T</strong> (<strong>Primary Tumor)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤ 2 cm, limited to the thyroid.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤ 1 cm, limited to the thyroid.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 1 cm but ≤ 2 cm, limited to the thyroid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 2 cm but ≤ 4 cm, limited to the thyroid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 4 cm, limited to the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or minimal <span class=\"customMeta\" data-dictid=\"756a84577116927771871853f8642e\">extrathyroidal</span> extension.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt; 4 cm, limited to the thyroid.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor with minimal <span class=\"customMeta\" data-dictid=\"756a84577116927771871853f8642e\">extrathyroidal</span> extension (e.g., <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor of any size with extensive <span class=\"customMeta\" data-dictid=\"756a84577116927771871853f8642e\">extrathyroidal</span> extension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> soft tissues, larynx, trachea, oesophagus, or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> or encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> vessels.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N (Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to level VI or VII <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes (pre-tracheal, paratracheal, and prelaryngeal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to unilateral, bilateral, or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or superior <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M</strong> <strong>(Distant Metastasis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> present.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IizCDVf56weWLTGk0eMU1744885223.mp3", "video": ""}, {"text": "All the following forms the boundaries of Beahrs' triangle except?", "options": [{"label": "A", "text": "Common Carotid Artery", "correct": false}, {"label": "B", "text": "Inferior Thyroid Artery", "correct": false}, {"label": "C", "text": "Recurrent Laryngeal Nerve", "correct": false}, {"label": "D", "text": "Superior Thyroid Artery", "correct": true}], "correct_answer": "D. Superior Thyroid Artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tFFQ3sWaEjeQRuKUwmok1739896086.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5alfBZzBo5xwL7qpFdO71744885050.mp3", "video": ""}, {"text": "A 60-year-old male undergoes a total thyroidectomy for a large multinodular goitre. Postoperatively, he experiences hoarseness and difficulty speaking. Which anatomical site is most commonly associated with this nerve injury during thyroidectomy?", "options": [{"label": "A", "text": "Right subclavian artery", "correct": false}, {"label": "B", "text": "Arch of the aorta", "correct": false}, {"label": "C", "text": "Berry’s ligament", "correct": true}, {"label": "D", "text": "Tubercle of Zuckerkandl", "correct": false}], "correct_answer": "C. Berry’s ligament", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uiqJazK2knabuoKyFBQn1739895837.png", "https://image.prepladder.com/content/eY5vFXIyOrsI1QADjads1739895936.png", "https://image.prepladder.com/content/HblPhlKtC5Tm4QO4OjXx1739895986.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gVzofvMkJhTfBJ6uiNKN1744884884.mp3", "video": ""}, {"text": "During thyroid surgery on a patient, significant bleeding occurs near the superior pole of the thyroid gland. Which vessel branches from the artery supplying this region?", "options": [{"label": "A", "text": "Common carotid artery", "correct": false}, {"label": "B", "text": "Subclavian artery", "correct": false}, {"label": "C", "text": "External carotid artery", "correct": true}, {"label": "D", "text": "Brachiocephalic trunk", "correct": false}], "correct_answer": "C. External carotid artery", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>External <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The superior pole of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> isthmus, larynx, and surrounding tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thyrocervical trunk (branch of the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> artery)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior pole of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroidea Ima Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable (may arise from the <span class=\"customMeta\" data-dictid=\"0ae7ec28011692777183f27e1ac870\">brachiocephalic</span> trunk, common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, or aortic arch)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides additional blood supply to the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HGTEncWxVkJJODEUW2Er1744884680.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 25-year-old male presents with right lower quadrant abdominal pain and is diagnosed with acute appendicitis. The surgical team plans to perform an appendectomy. Which of the following correctly represents the type of Incision used in appendicectomy? a-Lanz b-Rutherford Morrison c-McBurney’s d-Paramedian", "options": [{"label": "A", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}, {"label": "B", "text": "1-a, 2-b, 3-c, 4-d", "correct": false}, {"label": "C", "text": "1-c, 2-b, 3-a, 4-d", "correct": true}, {"label": "D", "text": "1-c, 2-a, 3-b, 4-d", "correct": false}], "correct_answer": "C. 1-c, 2-b, 3-a, 4-d", "question_images": ["https://image.prepladder.com/content/kG9NiVPgc1zSurnPFoLR1739937910.png"], "explanation_images": ["https://image.prepladder.com/content/D7heoxO2UvhDOxCfG0fv1739937976.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>McBurney's incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Centered on McBurney's point, perpendicular to the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ASIS line</li>\n<li>Junction of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 1/3 from <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> &amp; <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 2/3 from ASIS</li>\n<li>McBurney's point corresponds to the base of the appendix</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Aka Grid iron <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / McArthur incision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lanz incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Placed transversely 2 cm below the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> on the line joining the midpoint of the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> to the midpoint of the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Cosmetically better incision</li>\n<li>Aka Modified McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / Rocky Davis <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / Bikini <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> (good <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rutherford-Morrison incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extension of McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for retrocecal appendicitis</li>\n<li>Upward &amp; laterally by cutting conjoint tendon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Muscle cutting incision</li>\n<li>Preferred for retrocecal appendix</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/E0My6vCEHJxk5pMk92201749131877.mp3", "video": ""}, {"text": "A 25-year-old male presents with right lower quadrant abdominal pain and is diagnosed with acute appendicitis. He undergoes an open appendectomy. Which of the following statements regarding the steps of an open appendectomy is incorrect?", "options": [{"label": "A", "text": "The incision is made at McBurney's point and extended down to the external oblique aponeurosis.", "correct": false}, {"label": "B", "text": "Cecum is identified with the help of taenia coli and ileocecal junction.", "correct": false}, {"label": "C", "text": "Mesoappendix and appendicular artery are ligated to prevent bleeding.", "correct": false}, {"label": "D", "text": "A lock-stitch suture is placed around the base of the appendix which is used to bury the stump after excision of the appendix.", "correct": true}], "correct_answer": "D. A lock-stitch suture is placed around the base of the appendix which is used to bury the stump after excision of the appendix.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ioked4tlA9VgFBgCdBN01739938080.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vPAI5UPRvoauq0iQ1Umt1746117177.mp3", "video": ""}, {"text": "A 34-year-old male undergoes an open appendectomy for acute appendicitis. The choice of incision was McBurney's incision. Postoperatively, after a few days, he presents with pain and bulging in the right lower quadrant, which is diagnosed as an indirect inguinal hernia. Which nerve injury during the appendectomy is most likely responsible for this complication?", "options": [{"label": "A", "text": "Ilioinguinal nerve", "correct": true}, {"label": "B", "text": "Femoral nerve", "correct": false}, {"label": "C", "text": "Genitofemoral nerve", "correct": false}, {"label": "D", "text": "Pudendal nerve", "correct": false}], "correct_answer": "A. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>MC <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complication</strong> involves infection at the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> site.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Intraabdominal abscess</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> within the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity, typically due to infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Ileus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary cessation of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function, leading to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension and discomfort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> leading to embolism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of blood clots in the veins, which can travel to the lungs or other parts of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> pyaemia (Pylephlebitis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, a rare but serious complication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> intestinal obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue causing <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction; <strong>MC late complication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Fecal fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage from the <span class=\"customMeta\" data-dictid=\"23c46c5fc916927771813b486e3774\">appendiceal</span> stump.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Nerve injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"108e66d0571692777189ff4a5e8740\">Ilioinguinal</span> nerve and <span class=\"customMeta\" data-dictid=\"240b25374316927771890d8646eda8\">iliohypogastric</span> nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jtbdLx4EbkXmzdmWtZ7k1746117544.mp3", "video": ""}, {"text": "A 28-year-old woman presented with a 3-day history of vague lower abdominal pain, low-grade fever, and urinary frequency. Initial pelvic examination and urinalysis were inconclusive. CT scan revealed acute appendicitis with an inflamed appendix located in the pelvis. The delayed diagnosis in this case was most likely due to:", "options": [{"label": "A", "text": "The appendix's pelvic location masking classic right lower quadrant signs", "correct": true}, {"label": "B", "text": "Misinterpretation of urinary symptoms as a primary urological issue", "correct": false}, {"label": "C", "text": "Lack of characteristic migration of pain from periumbilical to right iliac fossa", "correct": false}, {"label": "D", "text": "Absence of typical anorexia and vomiting in early appendicitis", "correct": false}], "correct_answer": "A. The appendix's pelvic location masking classic right lower quadrant signs", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hAgS4QBwErYjDedeEGfv1739937721.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrocecal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May present with <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> or back pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subcecal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"c2f4c63c3316927771885c7b34313e\">gynecological</span> disorders or <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pre-ileal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-ileal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paracecal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can present with typical right lower <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subhepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be mistaken for cholecystitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pelvic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> symptoms of <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease or ovarian pathology</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5xYmtKmNzbpay7SyEKEi1746112918.mp3", "video": ""}, {"text": "A 28-year-old male presents with right lower quadrant pain, nausea, and low-grade fever. Upon examination, he exhibits rebound tenderness at McBurney's point. Which of the following is the most likely initial event in the pathogenesis of this patient's condition?", "options": [{"label": "A", "text": "Bacterial invasion of the appendiceal wall", "correct": false}, {"label": "B", "text": "Obstruction of the appendiceal lumen", "correct": true}, {"label": "C", "text": "Thrombosis of appendiceal vessels", "correct": false}, {"label": "D", "text": "Perforation of the appendix", "correct": false}], "correct_answer": "B. Obstruction of the appendiceal lumen", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2toBuxcIB59LDuzhL59M1739937831.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eCTgiVK27MDFgRr4Ww3T1746113027.mp3", "video": ""}, {"text": "A 22-year-old male presents with right lower quadrant pain for the past 24 hours. On examination, the surgeon demonstrates cutaneous hyperesthesia in an area bounded by a line joining the anterior superior iliac spine, the umbilicus, and the pubic symphysis. Which of the following statements is most accurate regarding this clinical sign?", "options": [{"label": "A", "text": "This sign is known as Sherren's triangle and indicates retro-cecal appendicitis", "correct": false}, {"label": "B", "text": "The hyperesthesia is due to irritation of the T10-L1 nerve roots by the inflamed appendix", "correct": true}, {"label": "C", "text": "This sign is highly specific for appendicitis and rules out other causes of right lower quadrant pain", "correct": false}, {"label": "D", "text": "The presence of this sign contraindicates the use of laparoscopy for appendectomy", "correct": false}], "correct_answer": "B. The hyperesthesia is due to irritation of the T10-L1 nerve roots by the inflamed appendix", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Option D)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial: Vague, <span class=\"customMeta\" data-dictid=\"68d37494591692777186d7c7ce4531\">dull</span> pain around the umbilicus.</p>\n<p>Progression: Pain localizes to the right lower <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RLQ) due to <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> involvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nausea and Vomiting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> inflammation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anorexia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of appetite.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenderness at McBurney's point (one-third of the distance from the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine to the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> on the right side).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rebound Tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased pain upon sudden release of pressure on the abdomen, indicating peritoneal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rovsing's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of the left lower <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> causes pain in the right lower quadrant, suggesting peritoneal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psoas Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain on <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension of the right hip, indicating <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of the <span class=\"customMeta\" data-dictid=\"0ad3d6d65d16927771893950d73d01\">iliopsoas</span> muscle group.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obturator Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain elicited by internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the right thigh while supine, suggesting <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of the <span class=\"customMeta\" data-dictid=\"215af9957a1692777194e73b21a340\">obturator</span> <span class=\"customMeta\" data-dictid=\"4bbfac0bec16927771902390ec8618\">internus</span> muscle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dunphy's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased pain in the RLQ with coughing, indicating peritoneal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aaron's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Referred pain in the <span class=\"customMeta\" data-dictid=\"b2332a96a2169277718756eb10e3e7\">epigastrium</span> upon pressure over McBurney's point.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ten Horn Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased pain during gentle <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> or pulling of the right <span class=\"customMeta\" data-dictid=\"bed7b691c316927772006c66a8ea06\">testicle</span> in male patients, suggesting an inflamed <span class=\"customMeta\" data-dictid=\"b790a83bb41692777181cc3c0232af\">appendix</span> close to the right <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CWfYJFjlFInXUIxq42NA1746113248.mp3", "video": ""}, {"text": "A 16-year-old male presents to the emergency department with a 12-hour history of abdominal pain. The pain was initially periumbilical and colicky in nature but has since localized to the right iliac fossa. He has also experienced one episode of vomiting and has no appetite. His Alvarado score is 5. What is the inference of this score?", "options": [{"label": "A", "text": "Negative for acute appendicitis", "correct": false}, {"label": "B", "text": "Diagnosis for acute appendicitis is confirmed", "correct": false}, {"label": "C", "text": "CECT is indicated in this patient", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. CECT is indicated in this patient", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MANTREL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Score</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Migratory pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anorexia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea, Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rebound tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated Temperature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leukocytosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shift to Left</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Score of 9-10: Diagnosis is certain</li>\n<li>Score of 7-8: High likelihood of diagnosis</li>\n<li>Score of 5-6: Equivocal (most dangerous)\n\t\t\t\t<ul>\n<li>CECT is indicated in cases of Equivocal MANTREL score findings to confirm the diagnosis.</li>\n</ul>\n</li>\n<li>Score of 1-4: Negative for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zn1UIaUVG4QxZFYIlKBa1746113411.mp3", "video": ""}, {"text": "Which of the following statements is true about acute appendicitis?", "options": [{"label": "A", "text": "Diagnosis in children can be done by clinical signs only", "correct": false}, {"label": "B", "text": "Diagnosis in adults requires additional imaging modalities", "correct": false}, {"label": "C", "text": "The gold standard test is the USG abdomen", "correct": false}, {"label": "D", "text": "A shift to the left in the leukocyte count is seen", "correct": true}], "correct_answer": "D. A shift to the left in the leukocyte count is seen", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DyZQJAj4tfrccC55YVQI1746113529.mp3", "video": ""}, {"text": "A 45-year-old male presents with a 3-day history of right lower quadrant pain, fever, and anorexia. His examination is significant for a palpable mass in the right lower quadrant with guarding and rebound. A CT scan demonstrates an appendiceal mass. He was admitted to the hospital and started on intravenous antibiotics. After 48 hours, his fever has resolved, and his abdominal pain has significantly improved. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Discharge home on oral antibiotics", "correct": false}, {"label": "B", "text": "Continue IV antibiotics and observe", "correct": true}, {"label": "C", "text": "Laparoscopic appendectomy", "correct": false}, {"label": "D", "text": "Colonoscopy", "correct": false}], "correct_answer": "B. Continue IV antibiotics and observe", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A conservative, non-surgical approach used in the management of <span class=\"customMeta\" data-dictid=\"00a7c7094b16927771811aa4aaf64b\">appendicular</span> lump or mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Nil <span class=\"customMeta\" data-dictid=\"a12b458e031692777195befcef5904\">per os</span> (NPO):</strong> No oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> to allow the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> system to rest.</p>\n<p>2. <strong>Intravenous fluids (IV fluids):</strong> Maintain <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> balance.</p>\n<p>3. <strong>Intravenous antibiotics:</strong> Initiated for all patients to control infection.</p>\n<p>4. <strong>Percutaneous drainage:</strong> Performed if an <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> is present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regular monitoring of pulse rate and temperature every 4 hours.</li>\n<li>Most patients show improvement within 24–48 hours.</li>\n<li>If improving, continue conservative management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative treatment typically lasts for several days. An <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> (interval) <span class=\"customMeta\" data-dictid=\"e322284d9e169277718125d5257b0b\">appendectomy</span> is performed 6–8 weeks later, once the <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> has resolved.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Required if:</p>\n<ul>\n<li>Patient's condition worsens (e.g., signs of generalized peritonitis).</li>\n<li>Rupture of <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or mass occurs.</li>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of an <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> may be considered as an alternative before surgery.</li>\n</ul>\n<p><strong>Interval appendectomy</strong>: Not recommended for all but considered in <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"641e78b4b416927771811108016ca6\">appendicitis</span> cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Avoids the risks associated with emergency surgery during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> inflammation.</li>\n<li>Provides time for <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> to subside, making surgery safer.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/a2C3xouyG86EEbQInxNL1746113680.mp3", "video": ""}, {"text": "A 55-year-old male with a history of appendicitis presents with severe right lower quadrant pain, fever, tachycardia, and tenderness. An ultrasound shows an appendix mass. Despite conservative treatment, his condition worsens. Which sign or symptom indicates the need for surgical intervention?", "options": [{"label": "A", "text": "Increased white blood cell count with stable abdominal findings", "correct": false}, {"label": "B", "text": "Rising pulse rate with increasing size of the appendix mass", "correct": true}, {"label": "C", "text": "Localized right iliac fossa pain with no change in pulse rate", "correct": false}, {"label": "D", "text": "Generalized abdominal pain with no fever", "correct": false}], "correct_answer": "B. Rising pulse rate with increasing size of the appendix mass", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Appendicular Perforation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appendix <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> causes peritoneal contamination, leading to peritonitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extremes of age (&lt;5 years, &gt;65 years)</li>\n<li>Immunosuppression</li>\n<li>Diabetes mellitus</li>\n<li>Faecolith obstruction</li>\n<li>Pelvic appendix</li>\n<li>Previous <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lumen <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (often by faecolith) increases <span class=\"customMeta\" data-dictid=\"603b3d38051692777190701f192c2a\">intraluminal</span> pressure.</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> occur.</li>\n<li>Bacterial invasion through the <span class=\"customMeta\" data-dictid=\"b790a83bb41692777181cc3c0232af\">appendix</span> wall.</li>\n<li>Ischemic <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> leads to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> and <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> of the peritoneum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial colicky <span class=\"customMeta\" data-dictid=\"b2e0d79656169277719549ef5b484e\">periumbilical</span> pain, progressing to intense RLQ pain.</li>\n<li>Signs of <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"8e8712947516927771951838cd4100\">peritonitis</span> (rigid abdomen, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sepsis).</li>\n<li>Systemic signs (fever, tachycardia, leukocytosis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management: Preoperative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intravenous fluid resuscitation</li>\n<li>Broad-spectrum antibiotics</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"237b2a1dfa1692777200a074fd1072\">thromboembolism</span> prophylaxis</li>\n<li>Hyperpyrexia treatment in children</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laparoscopic <span class=\"customMeta\" data-dictid=\"e322284d9e169277718125d5257b0b\">appendectomy</span> is preferred for quicker recovery and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> wound infection risk.</li>\n<li><strong>Indicators for stopping <span class=\"customMeta\" data-dictid=\"c65831e9cb1692777185d546421397\">conservative treatment</span> of an <span class=\"customMeta\" data-dictid=\"b790a83bb41692777181cc3c0232af\">appendix</span> mass and planning <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention:</strong>\n<ul>\n<li><strong>Rising Pulse Rate: </strong>Indicates worsening infection and potential sepsis; requires immediate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention. <strong>(Option</strong> <strong>B)</strong></li>\n<li><strong>Spreading <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Pain: </strong>Suggests peritonitis, moving beyond the right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> fossa; necessitates immediate surgery.</li>\n<li><strong>Increasing Mass Size:</strong> Indicates potential <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> growth or inadequate infection containment; requires <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> and possible appendicectomy. <strong>(Option</strong> <strong>B)</strong></li>\n</ul>\n</li>\n<li>Drain <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> if present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/meuQy1i4z27rr08HAVjs1746116459.mp3", "video": ""}, {"text": "A 30-year-old female presents with right lower quadrant abdominal pain and is diagnosed with acute appendicitis. During surgery, a small mass is found at the tip of the appendix, which is subsequently identified as a carcinoid tumour. Which of the following statements about carcinoid tumours in the appendix is correct?", "options": [{"label": "A", "text": "They are most commonly found at the base of the appendix.", "correct": false}, {"label": "B", "text": "They typically produce excessive amounts of insulin.", "correct": false}, {"label": "C", "text": "For carcinoid tumors &amp;gt;2cm, right hemicolectomy is the preferred modality of treatment", "correct": true}, {"label": "D", "text": "They are associated with a high risk of metastasis.", "correct": false}], "correct_answer": "C. For carcinoid tumors &gt;2cm, right hemicolectomy is the preferred modality of treatment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MC Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tip of the appendix</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mostly discovered incidentally during surgery</li>\n<li>Larger tumors may cause <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, flushing, and <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> due to hormone secretion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone Secretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secretes <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> and other <span class=\"customMeta\" data-dictid=\"1059a0d9031692777201a8d8debd5e\">vasoactive</span> substances.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low for tumors &lt;2 cm</li>\n<li>Higher for tumors &gt;2 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirmed by histopathological examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>&lt;2 cm</strong>: Appendectomy</li>\n<li><strong>&gt;2 cm</strong>: Right hemicolectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZjgYI1LpoLoadUb1TDJq1746116641.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old male presents to the emergency department with severe chest pain following forceful vomiting. Physical examination reveals subcutaneous emphysema. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myocardial Infarction", "correct": false}, {"label": "B", "text": "Boerhaave's Syndrome", "correct": true}, {"label": "C", "text": "Acute Pancreatitis", "correct": false}, {"label": "D", "text": "Gastric Ulcer Perforation", "correct": false}], "correct_answer": "B. Boerhaave's Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Esophageal perforation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A breach in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall leads to leakage and increased <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iatrogenic injury, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> (Boerhaave's syndrome), foreign bodies, <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances, <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> esophagitis, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Varies by cause and location:</li>\n<li>Iatrogenic (recent instrumentation)</li>\n<li>Boerhaave's (vomiting, chest pain, emphysema)</li>\n<li>Cervical (neck pain, etc.)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging: Chest X-ray, contrast swallow studies, CT scan</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seal perforation, ensure drainage, supportive measures (nutrition, <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">cardiorespiratory</span> support, <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> control)</li>\n<li>Conservative Management: Suitable for stable patients: antibiotics, nil by mouth, observation</li>\n<li>Endoscopic Interventions: Visualization, retrieval, sealing with clips/stents, <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube placement</li>\n<li>Surgical Intervention: Required for significant sepsis, large perforations, pleural involvement, delayed presentation</li>\n<li>Surgical Options: Primary repair, controlled <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> creation, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> diversion, <span class=\"customMeta\" data-dictid=\"5871c6089b1692777187961e72bc82\">esophagectomy</span> (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kskS1UnptNDBLp3NMLd01748967532.mp3", "video": ""}, {"text": "A 45-year-old woman presents with fatigue, difficulty swallowing and pale skin. Investigation reveals a cervical esophageal web. Which of the following conditions is most likely?", "options": [{"label": "A", "text": "Achalasia", "correct": false}, {"label": "B", "text": "Barrett’s Esophagus", "correct": false}, {"label": "C", "text": "Plummer-Vinson Syndrome", "correct": true}, {"label": "D", "text": "Esophageal Carcinoma", "correct": false}], "correct_answer": "C. Plummer-Vinson Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Plummer Vinson Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A rare condition affecting middle-aged women.</li>\n<li>Characterized by a <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> web, iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia, and dysphagia.</li>\n<li>Cervical <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> Web\n\t\t\t\t<ul>\n<li>Thin <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> narrowing the upper esophagus</li>\n</ul>\n</li>\n<li>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia\n\t\t\t\t<ul>\n<li>Insufficient iron causes fatigue, shortness of breath, pale skin</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Dysphagia: Difficulty swallowing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iron/nutritional deficiencies</li>\n<li>Genetic factors</li>\n<li>Autoimmune conditions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased risk of post-cricoid and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iron supplements</li>\n<li>Dietary modifications,</li>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> if necessary</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kRHL0vVoJjvudOwvrtpb1748967183.mp3", "video": ""}, {"text": "A 70-year-old male with a history of smoking presents with progressive dysphagia and weight loss. Endoscopy reveals a mass in the mid-esophagus. Biopsy confirms squamous cell carcinoma. Imaging shows the tumor invading the muscularis propria and metastasis to three regional lymph nodes. What is the TNM classification for this patient?", "options": [{"label": "A", "text": "T2 N1 M0", "correct": false}, {"label": "B", "text": "T2 N2 M0", "correct": true}, {"label": "C", "text": "T3 N2 M0", "correct": false}, {"label": "D", "text": "T2 N3 M1", "correct": false}], "correct_answer": "B. T2 N2 M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TNM Staging- <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> Esophagus</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"11\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No primary tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-grade <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (malignant cells confined by basement membrane)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria, <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> mucosae, or submucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria or <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> mucosae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades submucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades adventitia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades adjacent structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades pleura, pericardium, <span class=\"customMeta\" data-dictid=\"9e415033a51692777182914ea1a92e\">azygos</span> vein, diaphragm, or peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invades aorta, vertebral body, or airway</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 1-2 regional nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 3-6 regional nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 7+ regional nodes</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fhmA9dWMfdlAIDylQDc81748966623.mp3", "video": ""}, {"text": "A 45-year-old man presents with progressive dysphagia for both solids and liquids over the past year. He also reports occasional chest pain, especially after eating. Manometry is performed and analyzed using the Chicago Classification. The results show spastic contractions in the distal esophagus. Based on these findings, what type of achalasia is most likely?", "options": [{"label": "A", "text": "Type I Achalasia", "correct": false}, {"label": "B", "text": "Type II Achalasia", "correct": false}, {"label": "C", "text": "Type III Achalasia", "correct": true}, {"label": "D", "text": "Diffuse Esophageal Spasm", "correct": false}], "correct_answer": "C. Type III Achalasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Esophageal Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Values</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1. Achalasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">contractility</span> <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, 100% failed peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Esophageal pan-pressurization <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, 100% failed <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> with ≥ 20% pan-esophageal pressurization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spastic contractions <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, ≥ 20% <span class=\"customMeta\" data-dictid=\"1ce806f0111692777198eedf1b5824\">spastic</span> contractions (DCI &gt; 8,000 mmHg·s·cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Esophagogastric Junction Outflow Obstruction (EGJOO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated integrated <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> pressure (IRP) with preserved peristalsis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, some preserved peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Distal <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> Spasm (DES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Premature (rapid) contractions with normal IRP<strong> (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal IRP, ≥ 20% <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> contractions (DL &lt; 4.5 s)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. Hypercontractile (Jackhammer) Esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extremely strong peristaltic contractions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal IRP, ≥ 20% hypercontractile contractions (DCI &gt; 8,000 mmHg·s·cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5. Ineffective <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> Motility (IEM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weak or failed peristalsis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal IRP, &gt; 50% ineffective swallows (DCI &lt; 450 mmHg·s·cm for weak peristalsis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6. Absent Contractility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete lack of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> contractility</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal IRP, 100% failed peristalsis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rzO9sCKmkxEufSvZpR7j1748965559.mp3", "video": ""}, {"text": "A 40-year-old man complains of a burning sensation in his chest and regurgitation after meals. Symptoms improve with antacids and have no significant weight loss. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Peptic ulcer disease", "correct": false}, {"label": "B", "text": "Gastroesophageal reflux disease (GERD)", "correct": true}, {"label": "C", "text": "Gastritis", "correct": false}, {"label": "D", "text": "Esophageal spasm", "correct": false}], "correct_answer": "B. Gastroesophageal reflux disease (GERD)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DDq0AFlKSmxpfzp4IJmp1748965945.mp3", "video": ""}, {"text": "Which of the following findings are diagnostic of nutcracker esophagus? Distal esophageal contraction amplitude &amp;gt; 180 mmHg Distal esophageal contraction amplitude &amp;gt; 45 mmHg Distal esophageal peristaltic wave duration &amp;gt; 6 cm Distal esophageal contraction amplitude &amp;lt; 30 mmHg Distal esophageal contraction duration &amp;gt; 6 seconds Multiple simultaneous contractions with an amplitude of &amp;gt; 30 mmHg.", "options": [{"label": "A", "text": "1 and 5", "correct": true}, {"label": "B", "text": "2 and 3", "correct": false}, {"label": "C", "text": "1, 3, and 5", "correct": false}, {"label": "D", "text": "2 and 6", "correct": false}], "correct_answer": "A. 1 and 5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessively intense, coordinated <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> contractions with normal <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia (solids and liquids)</li>\n<li>Severe chest pain</li>\n<li>Less common regurgitation</li>\n<li>Globus sensation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (&gt;180 mmHg)</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> duration (&gt;6 seconds)</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure and relaxation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Corkscrew\" or \"rosary bead\" appearance due to intense contractions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically normal mucosa</p>\n<p>Used to rule out structural abnormalities</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dietary Modifications: Smaller, frequent meals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium Channel Blockers (e.g., nifedipine)</li>\n<li>Nitrates (e.g., <span class=\"customMeta\" data-dictid=\"2805ce68a3169277719040c558e937\">isosorbide</span> dinitrate)</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> Injection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">Myotomy</span> (rare)</li>\n<li>Peroral <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">Myotomy</span> (POEM)</li>\n<li>Severe cases may require Esophagectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilation (less effective)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KbI8uod6D5jgShdZi5DC1748966176.mp3", "video": ""}, {"text": "Match the following conditions with its endoscopy images A) Esophageal candidiasis 1) B) Feline esophagitis 2) C)Herpes simplex esophagitis 3) D)CMV esophagitis 4)", "options": [{"label": "A", "text": "A-2, B-4, C-1, D-3", "correct": false}, {"label": "B", "text": "A-3, B-4, C-1, D-2", "correct": true}, {"label": "C", "text": "A-4, B-3, C-2, D-1", "correct": false}, {"label": "D", "text": "A-1, B-4, C-2, D-3", "correct": false}], "correct_answer": "B. A-3, B-4, C-1, D-2", "question_images": ["https://image.prepladder.com/content/97fq5nDOPjEs8zl1EicE1739939490.png", "https://image.prepladder.com/content/YtaPD3P3eJyeZ6VWqBEF1739939235.png", "https://image.prepladder.com/content/CxV6CfHvJmv16p03D7tJ1739939171.png", "https://image.prepladder.com/content/vA4pEcu6qx2fnjTr4cRN1739939636.png"], "explanation_images": ["https://image.prepladder.com/content/AEhJyKRbChAwZOQFz0aX1739939145.png", "https://image.prepladder.com/content/4sQhOOBMku8B501Q4rF91739939385.png", "https://image.prepladder.com/content/uLngJ9r8XRggpRn5bSvY1739939309.png", "https://image.prepladder.com/content/MoJQESFehvV7RpcwBnei1739939254.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal candidiasis</strong></p>\n\t\t\t \n\n\t\t\t<p>Characterized by white, raised plaques that resemble cottage cheese or curd. These plaques are adherent and often found along the entire length of the esophagus. The surrounding <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may appear erythematous and friable.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Esophageal_candidiasis.jpg\" data-tags=\"\" height=\"600\" src=\"https://image.prepladder.com/content/AEhJyKRbChAwZOQFz0aX1739939145.png\" width=\"600\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feline esophagitis</strong></p>\n\t\t\t \n\n\t\t\t<p>Often presents with <span class=\"customMeta\" data-dictid=\"9bb62139a81692777184648bfef564\">concentric</span> rings, giving the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> a \"feline\" appearance,</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Donald E. Mansell, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Herpes_esophagitis.JPG\" data-tags=\"\" height=\"366\" src=\"https://image.prepladder.com/content/4sQhOOBMku8B501Q4rF91739939385.png\" width=\"400\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herpes simplex esophagitis</strong></p>\n\t\t\t \n\n\t\t\t<p>Typically presents with multiple small, well-circumscribed, <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> ulcers. These ulcers are often located in the mid-to-distal esophagus. The surrounding <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may be erythematous.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Frank Gaillard\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/feline-oesophagus-photo\" data-tags=\"\" height=\"452\" src=\"https://image.prepladder.com/content/uLngJ9r8XRggpRn5bSvY1739939309.png\" width=\"400\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CMV esophagitis</strong></p>\n\t\t\t \n\n\t\t\t<p>Characterized by large, <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> or <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> ulcers, often located in the mid-to-distal esophagus. The ulcers may have a well-defined border and are surrounded by relatively normal mucosa.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Yeh, Pai-Jui &amp; Wu, Ren-Chin &amp; Chen, Chien-Ming &amp; Chiu, Cheng-Tang &amp; Lai, Ming-Wei &amp; Chen, Chien-Chang &amp; Kuo, Chia-Jung &amp; Hsu, Jun-Te &amp; Su, Ming-Yao &amp; Le, Puo-Hsien.\" data-hash=\"\" data-license=\"cc by 4.0\" data-source=\"https://www.researchgate.net/figure/Endoscopic-features-of-CMV-esophagitis-A-Inflammation-B-polypoid-lesion-C-F_fig2_359212131\" data-tags=\"\" height=\"393\" src=\"https://image.prepladder.com/content/MoJQESFehvV7RpcwBnei1739939254.png\" width=\"400\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding the esophagus?", "options": [{"label": "A", "text": "The upper esophageal sphincter is composed of the thyropharyngeus and cricopharyngeus muscles", "correct": false}, {"label": "B", "text": "The lower esophageal sphincter is a physiological entity", "correct": false}, {"label": "C", "text": "The cervical esophagus is supplied by the inferior thyroid artery", "correct": false}, {"label": "D", "text": "All are true", "correct": true}], "correct_answer": "D. All are true", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> of the esophagus, at the neck</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle Composition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior pharyngeal <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> composed of the <strong>thyropharyngeus and cricopharyngeus muscles (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness Point</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The transition between the thyropharyngeus (oblique fibers) and cricopharyngeus (horizontal fibers) creates the Killian <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (site of Zenker diverticulum)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The lower end of the esophagus, in the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> 4 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevents <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> and duodenal contents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specialty</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> zone of high pressure <strong>(Option B)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Arterial Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Venous Drainage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical Esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> arteries<strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic Esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descending <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> aorta, bronchial arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Azygos and hemiazygos veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal Esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery, paired <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Drains into <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> and <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> systems via left and right <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> veins, left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> (coronary) vein, and short <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> veins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/znnYVXMfpq6pp8qwSvw61748963915.mp3", "video": ""}, {"text": "A 60-year-old male patient complains of intermittent dysphagia and episodes of food obstruction. Endoscopy reveals a fibrous band at the gastroesophageal junction. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Esophageal Web", "correct": false}, {"label": "B", "text": "Zenker's Diverticulum", "correct": false}, {"label": "C", "text": "Barrett's Esophagus", "correct": false}, {"label": "D", "text": "Schatzki Ring", "correct": true}], "correct_answer": "D. Schatzki Ring", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Schatzki Ring</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> constricting band of <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue located at the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (GEJ).</li>\n</ul>\n<ul>\n<li>Characteristics\n\t\t\t\t<ul>\n<li>Proximal side lined with <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelium</li>\n<li>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> side lined with columnar epithelium</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exact cause unclear</li>\n<li>Linked to <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease (GERD)</li>\n<li>Often associated with hiatal hernia</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia (difficulty swallowing)</li>\n<li>Food obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Barium esophagram</li>\n<li>Endoscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> using <span class=\"customMeta\" data-dictid=\"e8c48eb2a21692777183e04db06291\">bougie</span> or balloon</li>\n<li>Biopsy to rule out malignancy</li>\n<li>Repeated <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> may be necessary for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/t7ybIqfOR0cDeiYvkfcu1748967427.mp3", "video": ""}, {"text": "A 60-year-old patient presents with late-onset difficulty swallowing and significant weight loss. Imaging reveals an aberrant right subclavian artery compressing the esophagus. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Achalasia", "correct": false}, {"label": "B", "text": "Esophageal Cancer", "correct": false}, {"label": "C", "text": "Dysphagia Lusoria", "correct": true}, {"label": "D", "text": "Schatzki's Ring", "correct": false}], "correct_answer": "C. Dysphagia Lusoria", "question_images": ["https://image.prepladder.com/content/CdXtUeX6QoWqLfIfIqsi1739938794.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Dysphagia Lusoria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> disorder due to <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the esophagus, mainly by an <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (ARSA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARSA from the left aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> passes behind/in front of the esophagus, causing compression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Difficulty <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> worsens with age, possible weight loss and nutritional deficiencies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Imaging studies (barium swallow, chest CT)</li>\n<li>Manometric studies are not typically helpful</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on symptom severity</p>\n<ul>\n<li>Dietary modifications for mild cases.</li>\n<li>Surgical intervention for severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:310px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptom Severity</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management Approach</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild to Moderate</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lifestyle and dietary modifications:\n\t\t\t\t<ul>\n<li>Avoid exacerbating foods, eat slower, chew well, take smaller bites, sip liquids,</li>\n<li>Reassurance</li>\n</ul>\n</li>\n<li>Medications\n\t\t\t\t<ul>\n<li>Acid <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> (proton pump inhibitors), <span class=\"customMeta\" data-dictid=\"d8793e74511692777196de9f892b3f\">promotility</span> agents (cisapride)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe or Refractory</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical Intervention\n\t\t\t\t<ul>\n<li>Remove <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> vessel, reconstruct position</li>\n</ul>\n</li>\n<li>Surgical Methods\n\t\t\t\t<ul>\n<li>Median sternotomy, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> approach, possible severing without reconstruction</li>\n</ul>\n</li>\n<li>Surgical Complications\n\t\t\t\t<ul>\n<li>Damage to nearby structures, altered <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to right upper extremity</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Surgical</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> (palliative): Temporary relief of dysphagia</li>\n<li>Interventional radiology: <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">Endovascular</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> of <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> vessel while maintaining blood flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ODVSk6fKc2RNFlilb78G1748967305.mp3", "video": ""}, {"text": "A 45-year-old man undergoes an endoscopy for evaluation of dysphagia and an incidental mass is discovered in the esophagus. An endoscopic ultrasound (EUS) shows a hypoechoic mass originating from the muscularis propria. Which of the following statements regarding the esophageal lesion is most accurate?", "options": [{"label": "A", "text": "Immediate biopsy and fine-needle aspiration (FNA) should be performed to confirm the diagnosis.", "correct": false}, {"label": "B", "text": "If the lesion is asymptomatic and small, it can be observed without biopsy.", "correct": true}, {"label": "C", "text": "The preferred treatment for small, symptomatic lesions is chemotherapy.", "correct": false}, {"label": "D", "text": "Large lesions (&amp;gt;5 cm) are best managed with radiofrequency ablation (RFA)", "correct": false}], "correct_answer": "B. If the lesion is asymptomatic and small, it can be observed without biopsy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Esophageal Leiomyomas</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoechoic masses beneath the mucosa, typically found in the middle to <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> esophagus</li>\n<li>Most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumor in the esophagus</li>\n<li>Often found incidentally during endoscopies</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arise from the <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria or <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> layer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually asymptomatic, but large tumors can cause <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> or discomfort</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Barium esophagram: Smooth <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defect</li>\n<li>Endoscopy: Round <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> with smooth overlying mucosa</li>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> (EUS): <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">Hypoechoic</span> with regular borders, originating from the fourth endosonographic layer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is recommended if <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> is observed during follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsies or FNAs are relatively contraindicated due to risk of scarring, which complicates enucleation<strong> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Approaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enucleation: Thoracoscopic approach for smaller tumors. <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> is not indicated <strong>(Option C ruled out)</strong></li>\n<li>Submucosal Tunneling <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> (STER): Minimally invasive, involves creating a <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> tunnel for resection</li>\n<li>Thoracoscopy: Suitable for larger tumors (&gt;5 cm) <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YbHKsGkzZk0Mewi7JS731748967031.mp3", "video": ""}, {"text": "A 62-year-old male presents with progressive dysphagia and weight loss over the past 3 months. An endoscopy reveals a tumor in the lower third of the esophagus. Biopsy confirms adenocarcinoma. Further investigation reveals, the tumor has invaded the muscularis propria but no distant metastasis is detected. Which treatment option is most appropriate for this patient?", "options": [{"label": "A", "text": "Endoscopic Mucosal Resection (EMR)", "correct": false}, {"label": "B", "text": "Endoscopic Submucosal Dissection (ESD)", "correct": false}, {"label": "C", "text": "Esophagectomy", "correct": true}, {"label": "D", "text": "Radiofrequency Ablation (RFA)", "correct": false}], "correct_answer": "C. Esophagectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Carcinoma Esophagus- Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accurate <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> is essential for treatment planning.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early-Stage Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endoscopic Mucosal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> (EMR):</strong> Removes <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> cancers (T1a) and early cancers with minimal <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> invasion (T1b). <strong>(Option A ruled out)</strong></li>\n<li><strong>Endoscopic <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">Submucosal</span> <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (ESD): </strong>Removes larger lesions with <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc resection. <strong>(Option B ruled out)</strong></li>\n<li><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA)</strong>: Treats early Barrett's esophagus-associated cancers. Uses heat to destroy cancer cells. No <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"c02ad9ae0f1692777198d76afc93c4\">specimen</span> for <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> assessment.<strong> </strong><strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locally Advanced Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Esophagectomy:</strong> Primary treatment for locally advanced cancer. Removes <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> and reconstructs the <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> using the stomach, jejunum, or colon. <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> approaches: transhiatal, transthoracic, minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> (MIE). <strong>(Option C)</strong></li>\n<li><strong>Multimodality Therapy: </strong><strong>Combines chemotherapy, radiation therapy, and surgery.</strong></li>\n<li><strong>Neoadjuvant Chemoradiation: </strong><strong>Shrinks the tumor before surgery. CROSS trial showed survival benefit for <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> chemoradiation followed by surgery.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palliative Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endoscopic Stenting:<strong> Maintains <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> patency, helps with <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> difficulties.</strong></li>\n<li>Chemotherapy: <strong>Slows cancer progression, shrinks the tumor.</strong></li>\n<li>Radiotherapy:<strong> Shrinks tumors, controls bleeding.</strong></li>\n<li>Brachytherapy:<strong> Internal radiation therapy <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> the tumor.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QXUEXTFUy1EQVwrAU9SX1748966788.mp3", "video": ""}, {"text": "A 55-year-old male with a history of smoking and heavy alcohol consumption presents with progressive dysphagia and significant weight loss. Endoscopy reveals an ulcerated lesion in the mid-esophagus, and biopsies confirm squamous cell carcinoma. What is the most appropriate initial diagnostic step to assess the extent of the disease?", "options": [{"label": "A", "text": "Chromoendoscopy", "correct": false}, {"label": "B", "text": "Barium contrast study", "correct": false}, {"label": "C", "text": "Endoscopic Ultrasound (EUS)", "correct": true}, {"label": "D", "text": "FDG-PET scan", "correct": false}], "correct_answer": "C. Endoscopic Ultrasound (EUS)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Carcinoma <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">Esophagus</span> - Risk factors, clinical features, investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Squamous Cell Carcinoma</li>\n<li>Adenocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Squamous Cell Carcinoma: Smoking, Alcohol, Hot beverages, N-nitroso foods,</li>\n<li>Adenocarcinoma: Obesity, <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">Gastroesophageal</span> reflux, Barrett's esophagus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive dysphagia, Anorexia, Weight loss, Odynophagia, Regurgitation.</li>\n<li>Advanced symptoms: Hoarseness, Aspiration, Choking, etc.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endoscopy: Tumor visualization, Biopsies, Chromoendoscopy , NBI</li>\n<li>Barium contrast study: Tumor as ulcerated/stenotic lesion</li>\n<li>Bronchoscopy: Check <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> spread</li>\n<li>Endoscopic &amp; <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> Ultrasonography:\n\t\t\t\t<ul>\n<li>EUS for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> tumor (T stage) and <span class=\"customMeta\" data-dictid=\"dfb43383f5169277719429a15f12a6\">paraesophageal</span> nodes <strong>(Option C)</strong></li>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> nodes with FNA</li>\n</ul>\n</li>\n<li>CT scan: Distant <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> assessment</li>\n<li>FDG-PET scan: Detects nodes/metastases, not for tumor staging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9CuFPyNEGLfkSxqdkoOa1748966479.mp3", "video": ""}, {"text": "A 60-year-old male with a 10-year history of chronic GORD presents for a follow-up endoscopy. The endoscopy shows a 3 cm segment of salmon-colored mucosa extending above the OGJ with biopsy-proven intestinal metaplasia. He has no nodularity or ulceration. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Annual surveillance endoscopy", "correct": false}, {"label": "B", "text": "Immediate endoscopic mucosal resection (EMR)", "correct": false}, {"label": "C", "text": "High-dose proton pump inhibitor (PPI) therapy and aspirin", "correct": true}, {"label": "D", "text": "Endoscopic ablation with radiofrequency ablation (RFA)", "correct": false}], "correct_answer": "C. High-dose proton pump inhibitor (PPI) therapy and aspirin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Barrett's Esophagus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complication of GORD</p>\n<p>Columnar <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> &gt;1 cm above OGJ</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Landmarks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>OGJ: <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> end of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> folds, not <span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\">diaphragmatic</span> pinch/squamocolumnar junction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prague C&amp;M: <span class=\"customMeta\" data-dictid=\"57793361701692777184c3bc13c91d\">circumferential</span> (C) and <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> (M) extent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic GORD</li>\n<li>Age &gt;50</li>\n<li>Smoking</li>\n<li>Central obesity</li>\n<li>Male</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-dysplastic: 0.2–0.5%/year</li>\n<li>Low-grade: 0.7%/year</li>\n<li>High-grade: 7%/year</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early identification/treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treat underlying GORD, same pharmacological therapy as <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> GORD</li>\n<li><strong>Chemoprevention: <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">Aspirin</span> + high-dose <span class=\"customMeta\" data-dictid=\"6d17c6d6f1169277719687447037f2\">PPI</span> improves outcomes </strong><strong>(Option C)</strong></li>\n<li>Dysplastic Treatment: Ablate/resect without <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> cancer, controversial in non-dysplastic</li>\n<li>Ablative Therapy: Flat lesions only, <span class=\"customMeta\" data-dictid=\"c2796f22d51692777197c577f7ccd4\">RFA</span> preferred</li>\n<li>EMR vs ESD\n\t\t\t\t<ul>\n<li>EMR: easier, piecemeal;</li>\n<li>ESD: <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc, better margins</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surveillance for recurrence/persistent Barrett's or neoplasia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s13oXusNKnsneFUx1PcT1748966346.mp3", "video": ""}, {"text": "A 55-year-old man presents with intermittent chest pain and difficulty swallowing for the past few months. The chest pain is often severe and mimics angina but is not related to exertion. His symptoms often occur at night. Barium swallow reveals a typical finding given below. Which of the following disorders is most likely responsible for these findings?", "options": [{"label": "A", "text": "Achalasia cardia", "correct": false}, {"label": "B", "text": "Gastroesophageal reflux disease (GERD)", "correct": false}, {"label": "C", "text": "Esophageal stricture", "correct": false}, {"label": "D", "text": "Diffuse esophageal spasm", "correct": true}], "correct_answer": "D. Diffuse esophageal spasm", "question_images": ["https://image.prepladder.com/content/uep3rNPEw45s7Y4z15Tl1739938753.png"], "explanation_images": ["https://image.prepladder.com/content/13aZkYlNiVxoLuI4IaDQ1739938637.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncoordinated, simultaneous contractions of the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with normal <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia (solids and liquids)</li>\n<li>Severe chest pain</li>\n<li>Less common regurgitation</li>\n<li>Globus sensation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal Manometry: </strong>Multiple simultaneous non-peristaltic contractions with an <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> of &gt; 30 mmHg; normal <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure and relaxation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram):</strong> \"Corkscrew\" or \"Rosary bead\" appearance.</p>\n<p><strong>(Option A)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Korkenzieher-%C3%96sophagus.jpg\" data-tags=\"\" height=\"599\" src=\"https://image.prepladder.com/content/13aZkYlNiVxoLuI4IaDQ1739938637.png\" width=\"348\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopy: </strong>Generally normal mucosa; rule out structural abnormalities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong> Dietary Modifications (smaller, frequent meals)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>Calcium Channel Blockers (e.g., nifedipine)</li>\n<li>Nitrates (e.g., <span class=\"customMeta\" data-dictid=\"2805ce68a3169277719040c558e937\">isosorbide</span> dinitrate)</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> Injection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical:</strong></p>\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">Myotomy</span> (rare)</li>\n<li>Peroral <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">Myotomy</span> (POEM)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic: </strong>Dilation (less effective)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xgIatPiE6LJcivZVo7pC1747829850.mp3", "video": ""}, {"text": "Which of the following is considered a minimally invasive procedure for treating achalasia cardia?", "options": [{"label": "A", "text": "Laparoscopic Heller's Cardiomyotomy", "correct": false}, {"label": "B", "text": "Partial Fundoplication", "correct": false}, {"label": "C", "text": "Per-Oral Endoscopic Myotomy (POEM)", "correct": true}, {"label": "D", "text": "Esophagectomy", "correct": false}], "correct_answer": "C. Per-Oral Endoscopic Myotomy (POEM)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/drPEazLgStandfc8msIf1739938593.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological Treatments</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium Channel Blockers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nitrates</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relax the LES.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>5'-Phosphodiesterase Inhibitors</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> <span class=\"customMeta\" data-dictid=\"20fced1d1f1692777188cf8c607e50\">GMP</span> to lower <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> (Botox) Injections</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporarily <span class=\"customMeta\" data-dictid=\"f10cda12751692777194bdb6fe768f\">paralyze</span> <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscles.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Surgical Interventions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bougie/Balloon Dilatation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ruptures <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscle fibers to reduce pressure.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatments</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laparoscopic Heller's Cardiomyotomy</li>\n</ul>\n<p>(Most common)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incision in <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscle to reduce pressure.</p>\n<p>It is often combined with a fundoplication. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Partial Fundoplication</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevents reflux; options include Dor or Toupet fundoplication. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Treatments</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Per-Oral <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">Myotomy</span> (POEM)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Newer Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedure involving <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> of <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscle fibers.<strong> (Option C)</strong></p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"600\" src=\"https://image.prepladder.com/content/drPEazLgStandfc8msIf1739938593.png\" width=\"600\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of Chronic Cases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Megaesophagus</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe cases may require <strong>esophagectomy</strong> (surgical removal of the esophagus). <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fJNRiOZNwZvWX40X59Fl1748965830.mp3", "video": ""}, {"text": "A 42-year-old man presents with progressive dysphagia for liquids more than solids over six months, regurgitation of undigested food, nocturnal cough, and unintentional weight loss. Which investigation is the gold standard for diagnosing his condition?", "options": [{"label": "A", "text": "Upper gastrointestinal endoscopy", "correct": false}, {"label": "B", "text": "High-resolution manometry", "correct": true}, {"label": "C", "text": "Barium swallow study", "correct": false}, {"label": "D", "text": "Chest X-ray", "correct": false}], "correct_answer": "B. High-resolution manometry", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VvpVn5103gvfT8aC5o5m1739938526.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is characterized by the progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall. This leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> and failure of the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold Standard: This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the esophagus. <strong>(Option A)</strong></p>\n<ul>\n<li>Elevated resting LES pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete LES relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the LES (Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance).</p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Achalasie_Stadium_2.jpg\" data-tags=\"\" height=\"599\" src=\"https://image.prepladder.com/content/VvpVn5103gvfT8aC5o5m1739938526.png\" width=\"322\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris, It is important to rule out other causes of <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> such as tumors.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9b4McnOVaAo1svlyK08c1748965670.mp3", "video": ""}, {"text": "Which of the following statements is true about the Zenker’s diverticulum?", "options": [{"label": "A", "text": "An enlarged diverticulum always results in desynchronization.", "correct": false}, {"label": "B", "text": "Halitosis is a symptom of an enlarged diverticulum.", "correct": true}, {"label": "C", "text": "Protrudes posteriorly below the cricopharyngeal sphincter.", "correct": false}, {"label": "D", "text": "Absence of a suture line increases the chance of a postoperative leak.", "correct": false}], "correct_answer": "B. Halitosis is a symptom of an enlarged diverticulum.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vOqIt9vKGTi64XYZNjmh1739938258.png", "https://image.prepladder.com/content/ocgRk0Lk6RTIvii3YUzR1739938342.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oGvudRmMiMDiIf9TpiHF1748965381.mp3", "video": ""}, {"text": "A 55-year-old woman with persistent GERD symptoms despite optimal medical therapy is considered for surgery. What is the most appropriate surgical procedure for her condition?", "options": [{"label": "A", "text": "Nissen fundoplication", "correct": true}, {"label": "B", "text": "Fontan procedure", "correct": false}, {"label": "C", "text": "Hartmann procedure", "correct": false}, {"label": "D", "text": "Heineke–Mikulicz pyloroplasty", "correct": false}], "correct_answer": "A. Nissen fundoplication", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gsvM9Z5Uxqb6JS0KN0Y41739938111.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/em2VfmQaDKliVVTxhwid1748965146.mp3", "video": ""}, {"text": "Which hormone is known to decrease LES pressure?", "options": [{"label": "A", "text": "Gastrin", "correct": false}, {"label": "B", "text": "Cholecystokinin", "correct": false}, {"label": "C", "text": "Progesterone", "correct": true}, {"label": "D", "text": "Motilin", "correct": false}], "correct_answer": "C. Progesterone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Increase <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Decrease <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cholecystokinin</li>\n<li>Gastrin</li>\n<li>Motilin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progesterone</li>\n<li>Estrogen</li>\n<li>Secretin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metoclopramide</li>\n<li>Domperidone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium channel blockers</li>\n<li>Nitrates</li>\n<li>Theophylline</li>\n<li>Anticholinergics</li>\n<li>Benzodiazepines</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physiological Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fasting</li>\n<li>Standing upright</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pregnancy</li>\n<li>Obesity</li>\n<li>Lying down</li>\n<li>Smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurotransmitters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acetylcholine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serotonin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal Hormones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Somatostatin</li>\n<li>Substance P</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasoactive intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> (VIP)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zollinger-Ellison syndrome</li>\n<li>GERD</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Scleroderma</li>\n<li>Diabetes Mellitus</li>\n<li>COPD</li>\n<li>Hiatus Hernia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3FLO9KeU3vSv5hjRpGTC1748965048.mp3", "video": ""}, {"text": "A 55-year-old patient reports chronic heartburn and difficulty swallowing. An upper endoscopy shows a part of the stomach protruding through the diaphragm. Which condition is most likely?", "options": [{"label": "A", "text": "Peptic ulcer disease", "correct": false}, {"label": "B", "text": "Hiatus hernia", "correct": true}, {"label": "C", "text": "Esophageal cancer", "correct": false}, {"label": "D", "text": "Gastritis", "correct": false}], "correct_answer": "B. Hiatus hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ueC14OSPhW2jeJ22qMsc1739938071.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I/Sliding <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">Hiatus</span> Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common type. The <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> and part of the stomach slide up through the diaphragm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II/Paraesophageal <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">Hiatus</span> Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Part of the stomach pushes through the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> next to the esophagus. The <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> remains in place.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III/Mixed <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">Hiatus</span> Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combines features of both sliding and <span class=\"customMeta\" data-dictid=\"dfb43383f5169277719429a15f12a6\">paraesophageal</span> hernias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves <span class=\"customMeta\" data-dictid=\"93943f6ee2169277720298325fd255\">viscera</span> other than the stomach in the <span class=\"customMeta\" data-dictid=\"5b1872b5931692777189aeb46fed63\">hernial sac</span> like colon</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PS4zKJNE2hxBRYdvqspb1748964898.mp3", "video": ""}, {"text": "A newborn male presents with severe respiratory distress and a scaphoid abdomen. Chest X-ray reveals bowel loops in the left thoracic cavity. Immediate surgical intervention is planned to repair the diaphragmatic defect. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Bochdalek hernia", "correct": true}, {"label": "B", "text": "Morgagni hernia", "correct": false}, {"label": "C", "text": "Rolling hiatus hernia", "correct": false}, {"label": "D", "text": "Sliding hiatus hernia", "correct": false}], "correct_answer": "A. Bochdalek hernia", "question_images": ["https://image.prepladder.com/content/oYJYtgtmbkborHInwjei1739937753.png"], "explanation_images": ["https://image.prepladder.com/content/zEf3alOAe3EwoiKlpgoZ1739937819.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Failure of <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of <span class=\"customMeta\" data-dictid=\"8f7c89df6e16927771951d19c26422\">pleuroperitoneal</span> canal, leading to direct communication between <span class=\"customMeta\" data-dictid=\"8067ea0c85169277719561c9591e9d\">pleura</span> and <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> on the left side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colon, occasionally small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> or stomach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoplasia (potentially bilateral)</li>\n<li>Decreased bronchial branch generation</li>\n<li>Extension of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> media beyond <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> bronchioles</li>\n<li>Decreased total lung mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Respiratory embarrassment</li>\n<li>Scaphoid abdomen</li>\n<li>Bowel sounds on the left side of the chest</li>\n<li>Mediastinal shift towards the right side</li>\n<li>Intestinal obstruction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vFDR9SYTHvyxZo51dobr1748964762.mp3", "video": ""}, {"text": "A newborn male, 1 day old, presents with persistent regurgitation of feeds and continuous drooling of saliva from the mouth. The baby exhibits frequent coughing and cyanosis, prompting an investigation that reveals a tracheoesophageal fistula. Which type is the most likely to be seen?", "options": [{"label": "A", "text": "Type A", "correct": false}, {"label": "B", "text": "Type B", "correct": false}, {"label": "C", "text": "Type C", "correct": true}, {"label": "D", "text": "Type E", "correct": false}], "correct_answer": "C. Type C", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kVCUDFmgH59yBOuKkg5G1739937889.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:677px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type C <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">Tracheoesophageal</span> fistula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aspect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Details</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>85% are blind upper end with lower end <span class=\"customMeta\" data-dictid=\"8c3efbee661692777184685e54c75e\">communicating</span> with the trachea(Type C); associated with VACTER anomalies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>VACTER Anomalies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>V - Vertebral defects</li>\n<li>A - Anal atresia</li>\n<li>C - <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> (e.g., <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> stenosis)</li>\n<li>T - <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">Tracheoesophageal</span> fistula</li>\n<li>R - <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">Radial</span> <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> agenesis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Regurgitation </strong></li>\n<li><strong>Drooling </strong></li>\n<li><strong>Cough</strong></li>\n<li><strong>Cyanosis</strong></li>\n<li><strong>Often associated with <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"4bd223bbfc1692777189a9f0a30432\">hydramnios</span> (50%).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Investigations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nasogastric tube obstruction</li>\n<li>Contrast study</li>\n<li>Chest X-ray</li>\n<li>Echocardiography</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical intervention</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/26uvrce1MR4zGus9Ilkd1748964610.mp3", "video": ""}, {"text": "A 35-year-old man ingests a household cleaner and sustains a corrosive injury to esophagus. Which of the following is false in this case?", "options": [{"label": "A", "text": "Neutralization with vinegar/citrus for alkali; antacids/milk/egg whites for acid", "correct": false}, {"label": "B", "text": "Early endoscopy is not preferred", "correct": true}, {"label": "C", "text": "Avoid emetics and sodium bicarbonate to prevent perforation", "correct": false}, {"label": "D", "text": "All are false", "correct": false}], "correct_answer": "B. Early endoscopy is not preferred", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alkali causes liquefaction, saponification, and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of vessels, leading to <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and stricture</li>\n<li>Acid causes intense pylorospasm, antral pooling, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> necrosis, and <span class=\"customMeta\" data-dictid=\"6b73f3afaa1692777187f2899b6934\">eschar</span> formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Phase Management</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neutralization: vinegar/citrus for alkali; antacids/milk/egg whites for acid <strong>(Option A ruled out)</strong></li>\n<li>Early <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> to assess severity and extent <strong>(Option B)</strong></li>\n<li>Avoid emetics and sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> to prevent <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"13\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management by Burn Degree</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1st Degree Burns:</p>\n<ul>\n<li>48 hours observation; oral feeds resumed once <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> is swallowed painlessly</li>\n<li>Regular follow-up <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> at 1st, 2nd, and 8th months to identify stricture</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"10\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2nd &amp; 3rd Degree Burns:</p>\n<ul>\n<li>Fluid therapy, antibiotics, nutrition, PPI’s and aerosolized steroids and resuscitation</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Fiberoptic-guided <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> intubation/tracheostomy if necessary</li>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> stenting, <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> for feeding</li>\n<li>Laparoscopy for evaluation; <span class=\"customMeta\" data-dictid=\"a422b7cfac1692777191bf0a3499e4\">laparotomy</span> in unstable patients</li>\n<li>Resection and end <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"c4b16dd0101692777187f46fd03084\">esophagostomy</span> with <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is full thickness</li>\n<li>Consider re-exploration after 36-48 hours if necessary</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> for stricture</li>\n<li>Use of various dilators (e.g., balloon, Savary-Gilliard, Eder-Puestow) for <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> dilatation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Considerations</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is technically difficult; <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> may be preferred</li>\n<li>Resection and end <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"c4b16dd0101692777187f46fd03084\">esophagostomy</span> with <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is full thickness</li>\n<li>A <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"2533659200169277718431206e4029\">conduit</span> may be used if the stomach is diseased</li>\n<li>Multiple strictures may require <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> transposition</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3GBgv28ULEsfuoKhg5Em1748964195.mp3", "video": ""}, {"text": "A 5-year-old boy swallowed a disk battery and an x-ray revealed that it was lodged in the esophagus. What is the next step in the management of this patient?", "options": [{"label": "A", "text": "Observe", "correct": false}, {"label": "B", "text": "Immediate endoscopic removal", "correct": true}, {"label": "C", "text": "Endoscopic removal after 1 day of observation", "correct": false}, {"label": "D", "text": "Endoscopic removal after 2 days of observation", "correct": false}], "correct_answer": "B. Immediate endoscopic removal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Category</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Indications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Management</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emergency</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (inability to handle oral secretions)</li>\n<li>Disk batteries</li>\n<li>Sharp-pointed objects</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> removal </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urgent </strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blunt objects</li>\n<li>Incomplete obstruction</li>\n<li>Multiple magnets (or single <span class=\"customMeta\" data-dictid=\"883e21a28016927771915738a46f85\">magnet</span> plus another ferromagnetic object within <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> reach)</li>\n<li>Coins</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic removal within 12 to 24 hours<strong> (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non Urgent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Objects in stomach &gt;2.5cm diameter</li>\n<li>Disc battery in the stomach for up to 48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> if asymptomatic</li>\n<li>Blunt objects that fail to pass the stomach in 3-4 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observation<strong> (Option A, D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5MXiu4cRXiT4PFh82uq91748964012.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 65-year-old male presents with a painful, irreducible groin hernia, severe colicky pain, bilious vomiting, and absence of faeces or flatus for 24 hours. The hernia is tense and extremely tender, with reddish-blue skin discolouration and no cough impulse. What is the immediate next step in management?", "options": [{"label": "A", "text": "Administer IV antibiotics and fluids and proceed with surgery", "correct": true}, {"label": "B", "text": "Immediate surgical repair with synthetic mesh", "correct": false}, {"label": "C", "text": "Apply cold compresses to the hernia to reduce swelling", "correct": false}, {"label": "D", "text": "Start oral antibiotics and monitor the hernia for changes", "correct": false}], "correct_answer": "A. Administer IV antibiotics and fluids and proceed with surgery", "question_images": ["https://image.prepladder.com/content/HICAhp6jVG81CJhgiSYN1740020144.png"], "explanation_images": ["https://image.prepladder.com/content/eO2MvSX6VxOndNwYjyqi1740020204.png", "https://image.prepladder.com/content/A5KDbNVZiLk5O6NAqiEC1740020261.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VVESLjp96eOBrDlVPGJL1749024383.mp3", "video": ""}, {"text": "A patient presents with an incisional hernia located just above the umbilicus in the midline of the abdomen. According to the EHS classification, how is this hernia classified?", "options": [{"label": "A", "text": "M1", "correct": false}, {"label": "B", "text": "M2", "correct": false}, {"label": "C", "text": "M3", "correct": true}, {"label": "D", "text": "L2", "correct": false}], "correct_answer": "C. M3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r1J6pYf769sBP5QkRkAa1740020922.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Midline</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subxiphoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epigastric</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Umbilical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infraumbilical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suprapubic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M5</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Lateral </strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subcostal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flank</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iliac</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lumbar</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L4</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5fNhnJSKPrJt78Mub12k1749025573.mp3", "video": ""}, {"text": "Which of the following is NOT typically considered an indication for surgical repair of an umbilical hernia in adults?", "options": [{"label": "A", "text": "Incarceration or strangulation of hernia contents", "correct": false}, {"label": "B", "text": "Hernia size &amp;gt;2 cm in diameter", "correct": false}, {"label": "C", "text": "Symptomatic hernia causing pain or discomfort", "correct": false}, {"label": "D", "text": "Hernia in a patient with a BMI of 32", "correct": true}], "correct_answer": "D. Hernia in a patient with a BMI of 32", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DhJ2WMTla1CEMqA55UPe1749025443.mp3", "video": ""}, {"text": "Which of the following is NOT a feature associated with the image shown below?", "options": [{"label": "A", "text": "Covered by amnion and peritoneum layers", "correct": false}, {"label": "B", "text": "Higher incidence of associated chromosomal abnormalities like Trisomy 13, 18, and 21", "correct": false}, {"label": "C", "text": "The defect is usually located to the right of the umbilical cord insertion", "correct": true}, {"label": "D", "text": "Can be associated with Beckwith-Wiedemann Syndrome", "correct": false}], "correct_answer": "C. The defect is usually located to the right of the umbilical cord insertion", "question_images": ["https://image.prepladder.com/content/kSC0CHyfPbxi6QNGi7vA1740021204.png"], "explanation_images": ["https://image.prepladder.com/content/dQCpOhB0Coo37iU2LRYy1740021337.png", "https://image.prepladder.com/content/jOB4ANJOwJ8jr35aWHEJ1740021282.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:685px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Omphalocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastroschisis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents protrude through the <strong>base of the umbilicus</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents protrude through a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> typically located to the<strong> right of the umbilicus. (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Covering</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> organs are covered by two layers: <strong>Amnion (outer) and <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> (inner)</strong>. <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> covers the exposed organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chromosomal abnormalities: </strong>Associated with <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">Trisomy</span> 13, 18, and 21. <strong>(Option B ruled out)</strong></li>\n<li>Other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations affect multiple systems in the following order: <strong>cardiovascular&gt; Muscular&gt; gastrointestinal&gt; genitourinary. </strong>(Mnemonic: \"CM GIGU\")</li>\n<li><strong>Beckwith-Wiedemann Syndrome: </strong>Can include hemihypertrophy, macroglossia, visceromegaly, omphalocele, and increased risk of hepatoblastoma.<strong> (Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fewer chromosomal abnormalities compared to omphalocele.</li>\n<li>Higher risk of intestinal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> and dysfunction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally poor due to associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations, which are the most common cause of death.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally better than <span class=\"customMeta\" data-dictid=\"fc7e9c02921692777194319bbee508\">omphalocele</span> due to fewer associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Omphalocele-drawing.jpg\" data-tags=\"\" height=\"287\" src=\"https://image.prepladder.com/content/dQCpOhB0Coo37iU2LRYy1740021337.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Centers for Disease Control and Prevention\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Gastroschisis-web.jpg\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/jOB4ANJOwJ8jr35aWHEJ1740021282.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AogpWiXuwjICk2ThczrW1749026004.mp3", "video": ""}, {"text": "A 75-year-old thin woman presents with intermittent pain and paresthesia along the medial aspect of her right thigh. She reports nausea and vomiting over the past few days. On examination, hip flexion and external rotation exacerbate her thigh pain. Which of the following signs is most specific for the likely diagnosis?", "options": [{"label": "A", "text": "Cough impulse", "correct": false}, {"label": "B", "text": "Howship-Romberg sign", "correct": true}, {"label": "C", "text": "Carnett's sign", "correct": false}, {"label": "D", "text": "Murphy's sign", "correct": false}], "correct_answer": "B. Howship-Romberg sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/e9gmXfoAPPtKnza3l82o1740020740.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cLRJ2HoQQ9OOAxQknDb51749025083.mp3", "video": ""}, {"text": "A 55-year-old woman presents with a painful lump in her lower right abdomen, lateral to the rectus muscle. The swelling becomes more prominent when she stands or coughs. CT scan shows a defect in the transversus abdominis aponeurosis. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Epigastric hernia", "correct": false}, {"label": "B", "text": "Umbilical hernia", "correct": false}, {"label": "C", "text": "Spigelian hernia", "correct": true}, {"label": "D", "text": "Incisional hernia", "correct": false}], "correct_answer": "C. Spigelian hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Do43wtabLPX8nhNUqLzi1740020591.png", "https://image.prepladder.com/content/zkCDLXaSFsRJStc0Sopg1740020647.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8Y2FQaUMhK2crnMzmdlb1749024934.mp3", "video": ""}, {"text": "A 60-year-old male patient presents with right lower abdominal swelling and is diagnosed with a sliding hernia. After discussing the risks, his surgery is planned for hernia repair. Which of the following statements regarding sliding hernia is true?", "options": [{"label": "A", "text": "More common in females than males", "correct": false}, {"label": "B", "text": "Anterior wall of the sac is formed by the viscera", "correct": false}, {"label": "C", "text": "There is an increased risk of bowel injury during management.", "correct": true}, {"label": "D", "text": "Most common content is the appendix.", "correct": false}], "correct_answer": "C. There is an increased risk of bowel injury during management.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LDyqkVPr0og031r1Bkg71740020518.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NGXiTKCJRRKbJaDqotYk1749024829.mp3", "video": ""}, {"text": "A 42-year-old woman with a history of Gardner’s syndrome presents with persistent abdominal pain and a palpable mass in the left lower quadrant. She has previously undergone an open proctocolectomy. Imaging studies reveal an infiltrative mass in the mesentery. What is the most appropriate management strategy for her recurrent intra-abdominal mass?", "options": [{"label": "A", "text": "Immediate systemic chemotherapy without further surgical intervention.", "correct": false}, {"label": "B", "text": "Wide local excision with a 2 cm margin, potentially followed by radiotherapy.", "correct": true}, {"label": "C", "text": "Hormonal therapy to manage the tumor.", "correct": false}, {"label": "D", "text": "Laparoscopic surgery to remove the tumor, given its lower risk of recurrence.", "correct": false}], "correct_answer": "B. Wide local excision with a 2 cm margin, potentially followed by radiotherapy.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MnMSU3v8xHEmxEgAziTF1749026139.mp3", "video": ""}, {"text": "A 45-year-old woman presents with a reducible swelling in the left groin below the inguinal ligament, suggesting a femoral hernia. The surgeon opts for a low approach to access the femoral canal directly without entering the inguinal canal. Which technique is most appropriate for this approach?", "options": [{"label": "A", "text": "Lockwood's technique", "correct": true}, {"label": "B", "text": "McEvedy's technique", "correct": false}, {"label": "C", "text": "Lotheissen's technique", "correct": false}, {"label": "D", "text": "McVay repair", "correct": false}], "correct_answer": "A. Lockwood's technique", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BJ1BGpzz5aLMVHg7pn7f1740020331.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lockwood's </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open, Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incision below <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> crease, directly over hernia; <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">Elective</span> repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>McEvedy's </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open, High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oblique <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> above inguinal ligament</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lotheissen's</strong><strong> (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open, High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Access through the inguinal canal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>McVay </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suturing <span class=\"customMeta\" data-dictid=\"c9ac184b521692777185f5b6c8e958\">conjoint tendon</span> to Cooper's ligament</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TEP (Totally Extraperitoneal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laparoscopic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesh placement without entering the peritoneal cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TAPP (Transabdominal Preperitoneal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laparoscopic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesh placement after entering the peritoneal cavity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S4TRplO53ZA91mNBc6sO1749024558.mp3", "video": ""}, {"text": "During laparoscopic inguinal hernia repair, which critical structure should the surgeon avoid to prevent significant bleeding?", "options": [{"label": "A", "text": "Obturator Artery", "correct": false}, {"label": "B", "text": "Accessory Obturator Artery", "correct": false}, {"label": "C", "text": "Corona Mortis artery", "correct": true}, {"label": "D", "text": "Superficial Epigastric Artery", "correct": false}], "correct_answer": "C. Corona Mortis artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3LON1lPbQeltkbuJh5GR1740019957.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fROZDx3p25hh5NYLEWAT1749024238.mp3", "video": ""}, {"text": "A 55-year-old woman with sudden groin pain and diarrhoea is found to have a small bulge in the right groin. She describes the pain as colicky and has symptoms resembling acute gastroenteritis. Which type of hernia is most likely associated with these symptoms?", "options": [{"label": "A", "text": "Littre’s hernia", "correct": false}, {"label": "B", "text": "Amyand’s hernia", "correct": false}, {"label": "C", "text": "Maydl’s hernia", "correct": false}, {"label": "D", "text": "Richter’s hernia", "correct": true}], "correct_answer": "D. Richter’s hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9UibsUUDUryh3uzKh2Zv1740021443.png", "https://image.prepladder.com/content/WC87c4FWwXNl4NeHixT41740021531.png", "https://image.prepladder.com/content/i5jXeaL4G72vFU4hsn5O1740021562.png", "https://image.prepladder.com/content/7q9UEKNrc14IvALaFOLH1740021623.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Images</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Richter’s <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Herniation of only a portion of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall (circumference) into the <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> sac.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"d56029b07a16927771992ec2224b0e\">strangulation</span> or <span class=\"customMeta\" data-dictid=\"d86cbff77f16927771901630221272\">incarceration</span> of part of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall while the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> remains intact.</li>\n<li><strong>Mimics <span class=\"customMeta\" data-dictid=\"9adfce14be1692777188e68f409265\">Gastroenteritis</span> </strong><strong>(</strong>Diarrhea, colicky pain)<strong> </strong>potentially delaying diagnosis and increasing the risk of complications like strangulation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/9UibsUUDUryh3uzKh2Zv1740021443.png\" width=\"500\"/>\n<p><strong>Seen in: </strong>(Narrow Defects)</p>\n<ul>\n<li>Paraumbilical Hernia</li>\n<li>Femoral Hernia</li>\n<li>Obturator Hernia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Littre’s Hernia</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves a Meckel’s <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> herniating into the sac.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/WC87c4FWwXNl4NeHixT41740021531.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amyand’s Hernia</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains the <span class=\"customMeta\" data-dictid=\"b790a83bb41692777181cc3c0232af\">Appendix</span> within the <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> sac.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/i5jXeaL4G72vFU4hsn5O1740021562.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maydl’s Hernia</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It involves two or more <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops that become <span class=\"customMeta\" data-dictid=\"82d35bb04b16927771904c3bed856c\">incarcerated</span> or <span class=\"customMeta\" data-dictid=\"d9baf86ccc16927771990943c3d6b1\">strangulated</span> within the <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> sac.</li>\n<li>The obstructed loop is present intraperitoneally and hence, easily missed during surgery.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Elroy Patrick Weledji, Martin Mokake, Marcelin Ngowe Ngowe\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2014/184873\" data-tags=\"\" height=\"357\" src=\"https://image.prepladder.com/content/7q9UEKNrc14IvALaFOLH1740021623.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qH0W97FptKOcUCR4CXve1749026254.mp3", "video": ""}, {"text": "A 72-year-old female presents with a non-reducible right groin bulge below the inguinal ligament, confirmed by ultrasound to extend into the femoral canal. According to the Gilbert classification, which type best describes this condition?", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 3", "correct": false}, {"label": "C", "text": "Type 6", "correct": false}, {"label": "D", "text": "Type 7", "correct": true}], "correct_answer": "D. Type 7", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong>: <strong>Indirect, small <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> that protrudes through the deep inguinal ring.</li>\n<li>It is typically small and often seen in <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong>: <strong>Indirect, medium hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>An <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> that is larger than <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> but does not yet cause significant <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the surrounding structures.</li>\n<li>Admits one finger but less than two-finger breadth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3</strong>: <strong>Indirect, large <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A significant <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> may extend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> or cause a more noticeable <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of structures.</li>\n<li>&gt; 2 Finger breath</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4</strong>: <strong>Direct hernia, involves the entire floor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A direct <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> that protrudes through the weakened area of the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall (Hesselbach's triangle), involving the entire floor of the inguinal canal.</li>\n<li>It has an intact internal ring.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 5</strong>: <strong>Direct hernia, diverticular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A direct <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> where the <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> resembles a diverticulum.</li>\n<li>It has an intact internal ring.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 6</strong>: <strong>Combined <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> (Romberg's hernia) </strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves both direct and <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> components, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as a pantaloon or saddleback hernia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 7</strong>: <strong>Femoral hernia</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> that protrudes through the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> canal, located below the inguinal ligament.</li>\n<li>It is less common and more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to complications like strangulation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XEP3t9qEa97YCRsg6byO1749020975.mp3", "video": ""}, {"text": "A 62-year-old male has a right groin bulge that worsens with standing and reduces when lying down. The bulge is medial to the inferior epigastric vessels. Based on the Nyhus classification, which type of hernia does this patient have?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III A", "correct": true}, {"label": "D", "text": "Type III B", "correct": false}], "correct_answer": "C. Type III A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indirect inguinal hernia <strong>(Option A ruled out)</strong></p>\n<ul>\n<li>Normal internal inguinal ring</li>\n</ul>\n<p>e.g., <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> hernia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indirect inguinal hernia (Option B ruled out)</strong></p>\n<ul>\n<li>Dilated internal inguinal ring</li>\n<li>Posterior inguinal wall intact</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A: </strong>Direct inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> <strong>(Option C)</strong></p>\n<p><strong>B: </strong>Indirect inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> <strong>(Option D ruled out)</strong></p>\n<ul>\n<li>Internal inguinal ring dilated</li>\n<li>Encroaching medially or destroying the <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> of the Hesselbach <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (e.g. scrotal sliding or pantaloon hernia)</li>\n</ul>\n<p><strong>C: </strong>Femoral hernia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV </strong><strong>(Recurrent Hernia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A: </strong>Direct</p>\n<p><strong>B</strong>: Indirect</p>\n<p><strong>C: </strong>Femoral</p>\n<p><strong>D: </strong>Combined</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/f7K2V0gBV1J80OIu7bp11749020853.mp3", "video": ""}, {"text": "A newborn is diagnosed with a congenital diaphragmatic hernia (CDH) and presents with severe respiratory distress. Physical examination revealed a scaphoid abdomen and a chest X-ray showed bowel loops in the thoracic cavity and a mediastinal shift. What is the most appropriate initial intervention to stabilise the infant before surgical repair?", "options": [{"label": "A", "text": "Bag-mask ventilation to ensure adequate oxygenation.", "correct": false}, {"label": "B", "text": "Placement of an Orogastric tube to decompress the stomach", "correct": true}, {"label": "C", "text": "IV Antibiotics to prevent infection in the herniated bowel.", "correct": false}, {"label": "D", "text": "Immediate surgery, irrespective of the status", "correct": false}], "correct_answer": "B. Placement of an Orogastric tube to decompress the stomach", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mHHPpsOZVr105R6PMjcV1749026565.mp3", "video": ""}, {"text": "A 12-year-old girl presents with abdominal pain and intermittent nausea. Physical examination reveals a large, non-tender abdominal mass in the left lower quadrant, contiguous with the small intestine in the mesentery. Based on the findings, which type of mesenteric cyst is most likely, and what is the preferred management approach?", "options": [{"label": "A", "text": "Enterogenous cyst; Resection and anastomosis", "correct": true}, {"label": "B", "text": "Chylolymphatic cyst; Enucleation", "correct": false}, {"label": "C", "text": "Hydatid cyst; Anti-parasitic therapy", "correct": false}, {"label": "D", "text": "Traumatic cyst; Observation", "correct": false}], "correct_answer": "A. Enterogenous cyst; Resection and anastomosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bhlN1SGR3nyDSiXONLaP1740021902.png", "https://image.prepladder.com/content/f38IIt7vHoTboUn1YRzU1740022039.png", "https://image.prepladder.com/content/1Nc2SER8ksdz5VwoNRuQ1740022064.png", "https://image.prepladder.com/content/ZJoahWVX0nK98wx5y0WK1740021990.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chylolymphatic (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterogenous (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arises from congenitally misplaced <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> tissue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Derived from a <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> or <span class=\"customMeta\" data-dictid=\"a474651a3816927771869b71041ec1\">duplication</span> of the intestine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesentery of the ileum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesentery of the small intestine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wall Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thinner wall,</strong> composed of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thicker wall, lined by <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> or chyle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucinous fluid</li>\n<li>Colorless or yellowish brown.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Independent blood supply.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shares a blood supply with the adjacent bowel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enucleation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resection of the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> and affected <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> segment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transillumination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transillumination (-ve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transillumination (+ve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/f38IIt7vHoTboUn1YRzU1740022039.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/1Nc2SER8ksdz5VwoNRuQ1740022064.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/e4STxdXtTouq0seKx6XR1749026730.mp3", "video": ""}, {"text": "Match the following hernias with their respective defects. Hernia Defect 1. Berger’s Hernia a) Defect in the conjoint tendon 2. Beclard’s Hernia b) Hernia into the pouch of Douglas 3. Ogilvie’s Hernia c) Hernia behind the Roux limb 4. Stammer’s Hernia d) Through the saphenous opening 5. Peterson Hernia e) Through transverse mesocolon after retro colic gastro-jejunostomy", "options": [{"label": "A", "text": "1-b, 2-d, 3-a, 4-e, 5-c", "correct": true}, {"label": "B", "text": "1-b, 2-c, 3-d, 4-a, 5-e", "correct": false}, {"label": "C", "text": "1-d, 2-a, 3-e, 4-b, 5-c", "correct": false}, {"label": "D", "text": "1-a, 2-d, 3-c, 4-e, 5-b", "correct": false}], "correct_answer": "A. 1-b, 2-d, 3-a, 4-e, 5-c", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Hernia</strong></th>\n<th><strong>Correct Defect</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Berger’s Hernia</strong></td>\n<td>Hernia into the <strong>pouch of Douglas</strong> (pelvic hernia)</td>\n</tr>\n<tr>\n<td><strong>Beclard’s Hernia</strong></td>\n<td>Through the <strong>Beclard’s triangle</strong>, near <strong>saphenous opening</strong></td>\n</tr>\n<tr>\n<td><strong>Ogilvie’s Hernia</strong></td>\n<td>Due to a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <strong>conjoint tendon</strong></td>\n</tr>\n<tr>\n<td><strong>Stammer’s Hernia</strong></td>\n<td><strong>Internal hernia</strong> through <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> mesocolon</td>\n</tr>\n<tr>\n<td><strong>Peterson Hernia</strong></td>\n<td><strong>Behind the Roux limb</strong>, common post-bypass complication</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Hernia Type</th>\n<th>Key Anatomical Detail</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Berger's</td>\n<td>Pelvic peritoneal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> into Douglas pouch</td>\n</tr>\n<tr>\n<td>Beclard's</td>\n<td>Type of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> passing through Beclard's triangle</td>\n</tr>\n<tr>\n<td>Ogilvie's</td>\n<td>Involves <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> wall defect, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <strong>conjoint tendon</strong></td>\n</tr>\n<tr>\n<td>Stammer’s</td>\n<td>Internal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> via <strong>transverse mesocolon</strong> post-retrocolic GJ</td>\n</tr>\n<tr>\n<td>Peterson's</td>\n<td>Space between Roux limb and <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> mesocolon</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MFERUdWnmDJhE3Kwxz5O1745395037.mp3", "video": ""}, {"text": "A day-old preterm infant is admitted with severe respiratory distress. Physical examination shows a scaphoid abdomen and chest X-rays reveal bowel loops in the thorax and a mediastinal shift. Despite intensive care, the infant's condition deteriorates rapidly and leads to death. Which of the following accurately describes a characteristic feature of the most common type of this condition?", "options": [{"label": "A", "text": "Left-sided posteromedial defect with herniation of small intestine", "correct": false}, {"label": "B", "text": "Right-sided anterolateral defect associated with herniation of the liver", "correct": false}, {"label": "C", "text": "Defective central tendon of the diaphragm", "correct": false}, {"label": "D", "text": "Failure of development of the pleuroperitoneal canal", "correct": true}], "correct_answer": "D. Failure of development of the pleuroperitoneal canal", "question_images": ["https://image.prepladder.com/content/b4wmMSr9tf5wD5M95MuH1740021719.png"], "explanation_images": ["https://image.prepladder.com/content/mLayqkrPmVpXuVnXHILM1740021794.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Bochdalek Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Morgagni Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Left-sided</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Right-sided</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Posterolateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Anteromedial</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herniated Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Small intestine, stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Transverse colon, sometimes liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Scaphoid abdomen, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress, <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Mostly <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">Asymptomatic</span> and Incidental</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<ul>\n<li>Pulmonary hypoplasia</li>\n<li>Pulmonary hypertension</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Less severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Polyhydramnios, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> LHR, and liver position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Rarely detected prenatally; usually diagnosed later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Generally Better prognosis</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JwcDQqziAYq3bXP80hpq1749026419.mp3", "video": ""}, {"text": "A 58-year-old male with chronic bronchitis, smoking history, and recent steroid use presents with a lower abdominal bulge that worsens with prolonged standing and heavy weight lifting. Which of these factors contributes to the risk of his condition? Chronic bronchitis Heavy weight lifting Smoking Steroid use", "options": [{"label": "A", "text": "1, 2, 3", "correct": false}, {"label": "B", "text": "1, 3, 4", "correct": false}, {"label": "C", "text": "2, 3, 4", "correct": false}, {"label": "D", "text": "1, 2, 3, 4", "correct": true}], "correct_answer": "D. 1, 2, 3, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Areas of Natural Weaknesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lumbar triangles</li>\n<li>Inguinal Canal</li>\n<li>Oesophageal hiatus, <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> cicatrix</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Developmental Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Failure of Closure:</strong></p>\n<ul>\n<li><strong>Patent <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis</strong></li>\n</ul>\n<p><strong>Congenital Hernias:</strong></p>\n<ul>\n<li>Morgagni and Bochdalek hernias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Injury and Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgical Incisions:</strong> weakened <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> at the site of incision</li>\n<li><strong>Traumatic Injuries</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XStXtpVlEIgrrv6AmO1g1749020449.mp3", "video": ""}, {"text": "Which technique of incisional hernia is done at point B?", "options": [{"label": "A", "text": "Onlay", "correct": false}, {"label": "B", "text": "Inlay", "correct": true}, {"label": "C", "text": "Retromuscular", "correct": false}, {"label": "D", "text": "Preperitoneal", "correct": false}], "correct_answer": "B. Inlay", "question_images": ["https://image.prepladder.com/content/wlKu5LXgonUo76QASSVb1740021017.png"], "explanation_images": ["https://image.prepladder.com/content/EB1WzXjeI2fSy3VlG3wu1740021104.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mesh Placement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inlay</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> itself</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesh is sutured to the edges of the fascial defect.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can be used for large defects where primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> isn't possible.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates due to <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> separation from fascial edges under <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onlay</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>On top of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath/external <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> aponeurosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subcutaneous tissue is dissected off; the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is closed primarily, and the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed on top and secured</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Technically easier and less invasive.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"84294069061692777198bdff94a950\">seroma</span> formation, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> infection, and skin necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retromuscular</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behind the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle but <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is opened, the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in the created space, and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is closed over it</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> well incorporated into tissues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More complex procedure, risk of injury to <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> bundles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preperitoneal</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peritoneum is separated from <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in this space, <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> is closed over it.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> incorporation, lower risk of adhesions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Technically challenging, risk of peritoneal tears.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wUn8Ov9XWeOn3d4ewCF41749025873.mp3", "video": ""}, {"text": "Which type of lumbar hernia is characterized by a protrusion just below the 12th rib?", "options": [{"label": "A", "text": "Petit's lumbar hernia", "correct": false}, {"label": "B", "text": "Grynfeltt-Lesshaft hernia", "correct": true}, {"label": "C", "text": "Gibbon's hernia", "correct": false}, {"label": "D", "text": "Pantaloon hernia", "correct": false}], "correct_answer": "B. Grynfeltt-Lesshaft hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/M85w7YNDoX94Og6HFy5L1740020840.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vVwkJ0iTwVLDfvxW26xH1749025310.mp3", "video": ""}, {"text": "A 55-year-old woman presents with a small, reducible swelling in her right groin area. Upon examination, you noticed that the swelling was located lateral to the femoral vessels. Which variant of femoral hernia is this most likely to be?", "options": [{"label": "A", "text": "Narath's hernia", "correct": true}, {"label": "B", "text": "Cloquet's hernia", "correct": false}, {"label": "C", "text": "Velpeau's hernia", "correct": false}, {"label": "D", "text": "Laugier's hernia", "correct": false}], "correct_answer": "A. Narath's hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3xuZhB2M7SXU4GWCUJ4A1740020406.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Narath's <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also known as <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> hernia.</li>\n<li>Protrudes through the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vein.</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> hip dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cloquet's <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behind <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also known as <span class=\"customMeta\" data-dictid=\"2f165e068c1692777195b269189e9f\">pectineal</span> hernia</li>\n<li>Extends through the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"2f165e068c1692777195b269189e9f\">pectineal</span> fascia.</li>\n<li>Lies <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vein.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Velpeau's <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In front of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> hernia.</li>\n<li>Protrudes through <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> covering <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> sheath.</li>\n<li>Lies <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laugier's <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Through Gimbernat's ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also known as lacunar hernia.</li>\n<li>Protrudes through the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the lacunar ligament.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serafini's hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Through iliopectineal fascia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hernia <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> passes between the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone.</li>\n<li>It can be mistaken for an <span class=\"customMeta\" data-dictid=\"215af9957a1692777194e73b21a340\">obturator</span> hernia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Kvd355PnmlgZfw50H8VQ1749024705.mp3", "video": ""}, {"text": "A 55-year-old man undergoes emergency inguinal hernia surgery. Postoperatively, he experiences persistent groin pain, raising concerns about nerve injury. Which nerve is most commonly injured during open inguinal hernia surgery?", "options": [{"label": "A", "text": "Iliohypogastric nerve", "correct": false}, {"label": "B", "text": "Ilioinguinal nerve", "correct": true}, {"label": "C", "text": "Genitofemoral nerve", "correct": false}, {"label": "D", "text": "Femoral nerve", "correct": false}], "correct_answer": "B. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iEA8jhTp8auzHZ6UN39k1749021451.mp3", "video": ""}, {"text": "A laparoscopic surgeon is repairing an inguinal hernia and wants to avoid using electrocautery in certain areas to prevent injury. Which anatomical region should the surgeon avoid?", "options": [{"label": "A", "text": "Triangle of Doom", "correct": false}, {"label": "B", "text": "Triangle of Pain", "correct": true}, {"label": "C", "text": "Triangle of Hesselbach", "correct": false}, {"label": "D", "text": "Triangle of Scarpa", "correct": false}], "correct_answer": "B. Triangle of Pain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FMqYnvyuqNPTEiknff121740019826.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triangle of Doom </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triangle of Pain </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boundaries:</strong></p>\n<ul>\n<li><strong>Medial:</strong> <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">Vas</span> deferens</li>\n<li><strong>Lateral:</strong> Gonadal vessels</li>\n<li><strong>Base:</strong> Fold of peritoneum</li>\n<li><strong>Apex:</strong> Deep inguinal ring</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boundaries:</strong></p>\n<ul>\n<li><strong>Medial:</strong> Gonadal vessels</li>\n<li><strong>Lateral: </strong>Fold of peritoneum</li>\n<li><strong>Superior:</strong> <span class=\"customMeta\" data-dictid=\"e0b3e69ab9169277718997e696a3ab\">Iliopubic</span> tract</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Content</strong>:</p>\n<p>Iliac vessels are located behind the peritoneal fold.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Content</strong>:<strong> </strong>(Medial to Lateral)</p>\n<ul>\n<li>Femoral nerve</li>\n<li>Femoral branch of the <span class=\"customMeta\" data-dictid=\"65280a763b1692777188eb28595e8b\">genitofemoral</span> nerve</li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong>:</p>\n<p>Sharp <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> in this area risks damaging the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> vessels, which can lead to severe <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and potentially life-threatening complications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong>:</p>\n<ul>\n<li>Potential risk of nerve damage if <span class=\"customMeta\" data-dictid=\"d4991429ac169277718750e171fb86\">electrocautery</span> is used.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh is the<strong> most commonly injured nerve.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s83Klgvn1GmiIDsCreF61749021226.mp3", "video": ""}, {"text": "A 62-year-old male presents with a progressively worsening right groin bulge over 6 months, causing discomfort during lifting or prolonged standing. The hernia is reducible, and he is scheduled for elective repair. What is the gold standard surgical technique for his inguinal hernia repair?", "options": [{"label": "A", "text": "Shouldice Repair", "correct": false}, {"label": "B", "text": "Lichtenstein Repair", "correct": true}, {"label": "C", "text": "Herniotomy", "correct": false}, {"label": "D", "text": "Stoppa Repair", "correct": false}], "correct_answer": "B. Lichtenstein Repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yTdIiGKBUfKnAemK0iz81740019448.png", "https://image.prepladder.com/content/6cvFz5z3OsrTFYV1s7Jz1740019506.png", "https://image.prepladder.com/content/TwAzONNK1AbcY59RTBnD1740019611.png", "https://image.prepladder.com/content/Sz4rcwej3IvANfCEfgbb1740019664.png", "https://image.prepladder.com/content/bFY6roMQxALdjUEKLRoL1740019701.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:514px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Anpol42\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bassini_Operation._The_first_suture.jpg\" data-tags=\"\" height=\"745\" src=\"https://image.prepladder.com/content/yTdIiGKBUfKnAemK0iz81740019448.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shouldice Repair:</strong> <strong>(Option A)</strong> involves a four-layer repair (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author='\"Kumar hari rajah M. Somanathan \"' data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"355\" src=\"https://image.prepladder.com/content/6cvFz5z3OsrTFYV1s7Jz1740019506.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TEP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TAPP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery done <strong>above the</strong> peritoneum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery done<strong> </strong><strong>beneath the</strong> peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lower risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and peritoneal complications.</li>\n<li>Reduced risk of adhesions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Larger working space</li>\n<li>Better visualisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smaller working spaces can make the procedure more technically challenging.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A higher risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> formation due to entry into the peritoneal cavity.</li>\n<li>Potential for increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain compared to TEP.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/p5SBluEvxm0u2NqxDx4d1749021114.mp3", "video": ""}, {"text": "A 67-year-old male presents with a gradually increasing bulge in his right groin, which becomes more prominent when standing and straining and can be reduced when lying down. The bulge is medial to the inferior epigastric vessels. Which statement best describes this inguinal condition?", "options": [{"label": "A", "text": "Direct hernia, passing through a defect in the abdominal wall.", "correct": true}, {"label": "B", "text": "Indirect hernia, passing through the deep inguinal ring into the scrotum.", "correct": false}, {"label": "C", "text": "Direct hernia, passing through the deep inguinal ring.", "correct": false}, {"label": "D", "text": "Indirect hernia, passing through a defect in the abdominal wall.", "correct": false}], "correct_answer": "A. Direct hernia, passing through a defect in the abdominal wall.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/miWozsDHOd1T8xUfja2h1740019334.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrudes directly through Hesselbach's triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">Processus</span> vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from testis</li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n\t\t\t \n\n\t\t\t<p><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zcU7IrNpcLE7nUxAOfzX1749020704.mp3", "video": ""}, {"text": "A 72-year-old man presents with a bulge in his lower abdomen that worsens with heavy lifting or coughing. Physical examination reveals a direct inguinal hernia. Which of the following correctly describes the boundaries of the involved anatomical triangle?", "options": [{"label": "A", "text": "Lateral: Inferior epigastric vessels; Medial: Rectus abdominis; Inferior: Inguinal ligament", "correct": true}, {"label": "B", "text": "Lateral: Rectus abdominis; Medial: Inguinal ligament; Inferior: Femoral vessels", "correct": false}, {"label": "C", "text": "Lateral: Femoral vessels; Medial: Rectus abdominis; Inferior: Superior epigastric vessels", "correct": false}, {"label": "D", "text": "Lateral: Inguinal ligament; Medial: Femoral vessels; Inferior: Rectus abdominis", "correct": false}], "correct_answer": "A. Lateral: Inferior epigastric vessels; Medial: Rectus abdominis; Inferior: Inguinal ligament", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Rx1KgG7nhizu4mcLPTHw1740019228.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QkUmg9zkCURmMGRL1upZ1749020564.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 36 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following macroscopic features is most characteristic of Crohn's disease compared to ulcerative colitis?", "options": [{"label": "A", "text": "Continuous inflammation from the rectum extending proximally", "correct": false}, {"label": "B", "text": "Erythematous, granular mucosa with superficial ulcerations", "correct": false}, {"label": "C", "text": "Deep, punched-out ulcers with transmural inflammation", "correct": false}, {"label": "D", "text": "Thickened bowel wall and mesenteric fat wrapping", "correct": true}], "correct_answer": "D. Thickened bowel wall and mesenteric fat wrapping", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KKevKbqYn3JYdgwyxUfa1739875889.png", "https://image.prepladder.com/content/4oGd8CQwUjOHOT32csXW1739875871.png", "https://image.prepladder.com/content/vEm1k0sqzOD5o5thaxm21739875926.png", "https://image.prepladder.com/content/imfhBfZ9OpVupKuvmIVg1739875937.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Ulcerative Colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Crohn's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rectum and colon, continuous; does not involve small intestine.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Any part of the GI tract; often the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> ileum, colon; can involve small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> and upper GI tract.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Extent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Continuous inflammation; no skip lesions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Patchy <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> with skip lesions between affected areas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Erythematous, <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> mucosa; <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Deep, <span class=\"customMeta\" data-dictid=\"7ab35d64bd16927771981c8135b442\">serpiginous</span> ulcers, especially on the mesenteric side.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Wall Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Mucosa and <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> only.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Transmural <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> through all <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> layers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Strictures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rare.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common due to <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fistulas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rare, usually perianal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common, including between <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops and adjacent organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fat Wrapping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Present; \"creeping fat\" around the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Thickened <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall; thickened <span class=\"customMeta\" data-dictid=\"9f51fc9a741692777192ec164a061f\">mesentery</span> with enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Images</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"DeRoche, Tom &amp; Yuan, Xiao &amp; Liu, Xiuli. \" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Gross-photograph-of-ulcerative-colitis-Diffuse-erythema-edema-and-many-inflammatory_fig1_263291122\" data-tags=\"\" height=\"376\" src=\"https://image.prepladder.com/content/KKevKbqYn3JYdgwyxUfa1739875889.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"PPSE15\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ResectedIleum.jpg\" data-tags=\"\" height=\"212\" src=\"https://image.prepladder.com/content/4oGd8CQwUjOHOT32csXW1739875871.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ulcerative Colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Crohn's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited to <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and submucosa.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transmural, affecting all <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall layers.</li>\n<li>Transmural <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">Lymphoid</span> Aggregates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly <span class=\"customMeta\" data-dictid=\"0d0b0bf80b1692777196a0d5a44e03\">polymorphonuclear</span> leukocytes in <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> with <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> cells, edema, hyperemia, and lymphangiectasia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crypt Abscesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be present, but not unique.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goblet Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucin <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> may occur.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not specifically noted.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in 60%-70% of cases; non-caseating.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphoid Aggregates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent unless deep <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> is present.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present, especially in non-ulcerated areas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crypt Architecture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often distorted with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> branching.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not specifically noted.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Images</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Furrie, Elizabeth &amp; Macfarlane, S &amp; Kennedy, A &amp; Cummings, John &amp; Walsh, S.V. &amp; O'Neil, D.A. &amp; Macfarlane, G.T.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Representative-histopathology-of-rectal-mucosa-from-a-patient-with-ulcerative-colitis_fig1_8084629\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/vEm1k0sqzOD5o5thaxm21739875926.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr Archana Bhat\" data-hash=\"\" data-license=\"NA\" data-source=\"https://ilovepathology.com/pathology-of-crohns-disease/\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/imfhBfZ9OpVupKuvmIVg1739875937.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aht9l4GTWuyAqYAXVVn61748939519.mp3", "video": ""}, {"text": "A 52-year-old male with a history of ulcerative colitis presents with severe abdominal pain and distention, fever, and tachycardia. He appears ill and is in significant discomfort. Lab tests show leukocytosis and electrolyte imbalances. An X-ray of the abdomen is taken. Which of the following surgical procedures is the most appropriate for this patient?", "options": [{"label": "A", "text": "Segmental Colectomy", "correct": false}, {"label": "B", "text": "Total Abdominal Colectomy with End Ileostomy", "correct": true}, {"label": "C", "text": "Diverting Loop Ileostomy with Colonic Lavage", "correct": false}, {"label": "D", "text": "Laparoscopic Colonic Decompression", "correct": false}], "correct_answer": "B. Total Abdominal Colectomy with End Ileostomy", "question_images": ["https://image.prepladder.com/content/fpzqNn7ABaoFRBLutSgj1739875681.png"], "explanation_images": ["https://image.prepladder.com/content/BhLBbTtIuE421tJZNX7z1739875720.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Imaging modalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominopelvic CT with Oral and IV Contrast</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-line imaging.</li>\n<li>Superior for assessing disease severity, evaluating complications (e.g., abscess, perforation), and distinguishing toxic <span class=\"customMeta\" data-dictid=\"944688061e16927771929fa8717176\">megacolon</span> from severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> colitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serial Plain <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Films</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Toxisches_Megacolon_bei_Colitis_ulcerosa.jpg\" data-tags=\"\" height=\"598\" src=\"https://image.prepladder.com/content/BhLBbTtIuE421tJZNX7z1739875720.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frequently used modality.</li>\n<li>For follow-up <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to monitor <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> dilation.</li>\n<li>CT is repeated if complications like abscesses are suspected.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Typical Features:</strong></p>\n<ul>\n<li>Greatest <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> in transverse/right <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> (&gt;6 cm, up to 15 cm)</li>\n<li>Haustral pattern absent/disturbed</li>\n<li>Pneumatosis</li>\n<li>Multiple air-fluid levels visible</li>\n<li>Deep mucosal ulcerations with air-filled crevices</li>\n<li>Increased small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> gas may predict toxic megacolon</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IBD-Related</strong>: <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">Intravenous</span> glucocorticoids (e.g., <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> 100 mg every 6-8 hours) as first-line therapy; <span class=\"customMeta\" data-dictid=\"f5c6632a3616927771907038875b57\">infliximab</span> or <span class=\"customMeta\" data-dictid=\"fa041055ec16927771858fe49c76d3\">cyclosporine</span> if no response within 3 days</li>\n<li><strong>C. difficile Colitis</strong>: Stop inciting antibiotics; steroids not used; metronidazole, vancomycin, or <span class=\"customMeta\" data-dictid=\"819cbae2ff16927772026a05a5a0e8\">fidaxomicin</span> for medical therapy; fecal <span class=\"customMeta\" data-dictid=\"04f4b6dbf71692777192ca0c4f70fa\">microbial</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> considered in some cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Absolute indications</strong>: Perforation, life-threatening hemorrhage, worsening toxicity, worsening dilatation</li>\n<li><strong>IBD</strong>: <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">Colectomy</span> if no improvement after 24-48 hours; <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">subtotal</span> <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">colectomy</span> preferred for emergency surgery</li>\n<li><strong>C. difficile</strong>: Surgery for perforation, necrosis, or severe complications; early <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">colectomy</span> reduces the mortality rate</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">Colectomy</span> with End Ileostomy</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Colonic perforation, necrosis, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Resolves <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome, lower mortality compared to <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> resection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>More invasive, <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> stomas in many cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diverting Loop <span class=\"customMeta\" data-dictid=\"fd21e4e7c116927771898e2055e14b\">Ileostomy</span> with <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">Colonic</span> Lavage</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No perforation, necrosis, or <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Minimally invasive, higher likelihood of <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> reversal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>May leave inflamed colon, slower recovery, potential ongoing critical illness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4KNc4ErrYxW1upbNFRQZ1748939305.mp3", "video": ""}, {"text": "A 38-year-old male presents with severe abdominal distension and diarrhea. His vitals show a heart rate of 125 beats/min, fever of 38.9°C, and a white blood cell count of 13,800/microL. A radiograph reveals colonic dilation of 7 cm. Which of the following additional findings would not confirm the diagnosis of toxic megacolon?", "options": [{"label": "A", "text": "Anemia", "correct": true}, {"label": "B", "text": "Altered sensorium", "correct": false}, {"label": "C", "text": "Hypotension", "correct": false}, {"label": "D", "text": "Electrolyte disturbances", "correct": false}], "correct_answer": "A. Anemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathogenesis and Risk Factors of Toxic Megacolon</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colonic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> increases <span class=\"customMeta\" data-dictid=\"c6f527a009169277719084484976fa\">inducible</span> <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> production, inhibiting smooth muscle tone and contributing to <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> dilatation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ulcerative <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> (most common)</li>\n<li>Infectious colitis: particularly <span class=\"customMeta\" data-dictid=\"27791cc8181692777184b363360a3c\">Clostridium</span> difficile infection</li>\n<li>Crohn's disease</li>\n<li>Hypokalemia</li>\n<li>Antimotility agents</li>\n<li>Opiates, Anticholinergics, Antidepressants</li>\n<li>Abrupt cessation of glucocorticoids</li>\n<li>Barium enemas; Colonoscopy/bowel preparation</li>\n<li>Sulfasalazine and <span class=\"customMeta\" data-dictid=\"6d5e3d7a581692777180b2d9761c6c\">5-ASA</span> compounds can <span class=\"customMeta\" data-dictid=\"eba5ba77ec169277719688fab52fb0\">precipitate</span> toxic megacolon</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis and Evaluation of Toxic Megacolon</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiographic Evidence:</strong> <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">Colonic</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> (diameter &gt;6 cm)</p>\n\t\t\t \n\n\t\t\t<p><strong>PLUS at least three of the following:</strong></p>\n<ul>\n<li>Fever &gt;38ºC</li>\n<li>Heart rate &gt;120 beats/min</li>\n<li>Neutrophilic <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> &gt;10,500/microL</li>\n<li>Anemia</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>PLUS at least one of the following:</strong></p>\n<ul>\n<li>Dehydration</li>\n<li>Altered <span class=\"customMeta\" data-dictid=\"6225472b721692777198a024b97292\">sensorium</span> <strong>(Option B)</strong></li>\n<li>Electrolyte disturbances <strong>(Option D)</strong></li>\n<li>Hypotension <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"944688061e16927771929fa8717176\">megacolon</span> (Hirschsprung's disease).</li>\n<li>Acquired <span class=\"customMeta\" data-dictid=\"944688061e16927771929fa8717176\">megacolon</span> (chronic constipation).</li>\n<li>Chagas megacolon.</li>\n<li>Colonic <span class=\"customMeta\" data-dictid=\"64d5399fc516927771968a57b51d9c\">pseudo-obstruction</span> (Ogilvie syndrome).</li>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> dysmotility.</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> from diverticulitis, volvulus, tumors.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GZdWPZ0ptLnNwQisq5Mn1748939164.mp3", "video": ""}, {"text": "A 32-year-old patient diagnosed with mild Crohn's disease affecting the ileocecal region presents to your clinic. The patient has mild symptoms with no significant systemic involvement. What is the most appropriate first-line drug to prescribe for this patient to induce remission in mild Crohn's disease?", "options": [{"label": "A", "text": "Prednisone", "correct": false}, {"label": "B", "text": "Azathioprine", "correct": false}, {"label": "C", "text": "Infliximab", "correct": false}, {"label": "D", "text": "Budesonide", "correct": true}], "correct_answer": "D. Budesonide", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9V2idI3UiZ1omUXBVFyI1739875027.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:348px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Mild Crohn's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Moderate to Severe Crohn's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Induction Therapy</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First-line</strong>: <span class=\"customMeta\" data-dictid=\"b43d582eda16927771835f2ed1d581\">Budesonide</span> (preferred for <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> disease) <strong>(Option D)</strong><strong> </strong>or aminosalicylates (e.g., mesalamine).</li>\n<li>Prednisone for those who do not respond to budesonide.<br/>\n<strong>(Option A)</strong></li>\n<li><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"b36da50c8d169277718782ffc6960b\">Enteral</span> nutrition.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First-line</strong>: Corticosteroids (e.g., <span class=\"customMeta\" data-dictid=\"5dff8e3fac1692777196f8c0c960f3\">prednisone</span> for short term) or biologics<br/>\n\t\t\t\tAnti-TNF agents (Infliximab, Adalimumab) <strong>(Option C)</strong></li>\n<li>Anti-integrin therapy (Vedolizumab)</li>\n<li>Anti-interleukin therapy (Ustekinumab)</li>\n<li><strong>Combination therapy</strong>: Anti-TNF agents plus immunomodulators (Azathioprine, 6-MP) <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maintenance Therapy</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First-line</strong>: Continue aminosalicylates if effective.</li>\n<li><strong>Alternative</strong>: Thiopurines (azathioprine, 6-MP) for patients intolerant to aminosalicylates.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anti-TNF monotherapy</strong>: Long-term for maintaining remission.</li>\n<li><strong>Combination therapy</strong>: Anti-TNF agents with immunomodulators (for severe cases or history of nonresponse to biologics).</li>\n<li>Continue anti-integrin or anti-interleukin agents for those <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> by these therapies</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regular follow-up to monitor symptoms and inflammation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ileocolonoscopy 6-12 months post-remission. Drug level monitoring and fecal calprotectin to assess mucosal healing.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of complex fistulising Crohn's disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Drug therapy</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>With Abscess:</strong></p>\n<ul>\n<li>Prompt <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> with <span class=\"customMeta\" data-dictid=\"0f1847372f1692777198d18a901c08\">seton</span> placement.</li>\n<li>Initiate anti-TNF therapy post-drainage.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Without Abscess:</strong></p>\n<ul>\n<li>EUA with <span class=\"customMeta\" data-dictid=\"0f1847372f1692777198d18a901c08\">seton</span> placement and anti-TNF therapy combined with antibiotics.</li>\n<li>Removal of setons based on clinical response and imaging.</li>\n<li>Consider switching biologics or further <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention if <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> does not heal.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Therapy:</strong></p>\n<ul>\n<li>Anti-TNF agents + antibiotics (metronidazole or ciprofloxacin).</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Alternative/ Adjunctive:</strong></p>\n<ul>\n<li>Thiopurines (azathioprine, 6-MP), other biologics (vedolizumab, ustekinumab, upadacitinib).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LbWzS39YigoMGSkQn1se1748937990.mp3", "video": ""}, {"text": "A patient with chronic ulcerative colitis who had undergone total proctocolectomy with ileal pouch-anal anastomosis has come to the department complaining of diarrhoea, abdominal pain, fever and malaise. On examination, hematochezia is noted. What is the first line of treatment here?", "options": [{"label": "A", "text": "Antibiotic therapy", "correct": true}, {"label": "B", "text": "Biologic agents", "correct": false}, {"label": "C", "text": "Probiotics", "correct": false}, {"label": "D", "text": "Pouch excision", "correct": false}], "correct_answer": "A. Antibiotic therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eIi1Qp1KuIGPug6SVWqg1748939035.mp3", "video": ""}, {"text": "A 45-year-old male with a long-standing history of chronic inflammatory bowel disease presents for routine follow-up. He undergoes a colonoscopy, during which suspicious lesions are identified. A biopsy confirms the presence of malignancy. Which of the following types of cancer is more commonly associated with Crohn's disease than with ulcerative colitis?", "options": [{"label": "A", "text": "Colon carcinoma", "correct": false}, {"label": "B", "text": "Small intestine carcinoma", "correct": true}, {"label": "C", "text": "Cholangiocarcinoma", "correct": false}, {"label": "D", "text": "Gastric cancer", "correct": false}], "correct_answer": "B. Small intestine carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bOdkVv6ZhJrFYh4yWmNZ1748938936.mp3", "video": ""}, {"text": "Which of the following would be a differentiating feature of Colitis-associated colon carcinoma (CAC) from sporadic colon cancer?", "options": [{"label": "A", "text": "Sporadic colon cancer develops due to chronic inflammation and dysplasia", "correct": false}, {"label": "B", "text": "CAC has a lower mortality", "correct": false}, {"label": "C", "text": "CAC is more common after the age of 30", "correct": true}, {"label": "D", "text": "Sporadic colon cancer is associated with young individuals", "correct": false}], "correct_answer": "C. CAC is more common after the age of 30", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Colitis-associated <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sporadic <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age group &gt;30 years</li>\n<li>Due to prolonged colitis</li>\n<li>Develops from <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> to <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> to carcinoma</li>\n<li>Dysplasia seen here is flat dysplasia</li>\n<li><strong>Pancolonic disease: </strong>multicentric and infiltrative</li>\n<li>Increased mortality <strong>(Option B)</strong></li>\n<li>Endoscopic removal or <span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\">colonoscopy</span> is done</li>\n<li>Interval cancers are possible</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age group &gt; 50 years</li>\n<li>Most common in 8th decade <strong>(Option D)</strong></li>\n<li>Most common site is the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon, with left-side predominance</li>\n<li>Usually arises from an <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyp<strong> (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5BRRe5jQnzMcWJpQp78Z1748938820.mp3", "video": ""}, {"text": "A 58-year-old male comes to the hospital complaining of intermittent pain in the anal region and intermittent diarrhea for 6 months. On examination, he was found to have complex perianal fistulas bilaterally, with skin tags, as shown in the image. His blood investigations reveal anemia. What could be the possible diagnosis leading to this?", "options": [{"label": "A", "text": "Crohn’s disease of anorectum", "correct": true}, {"label": "B", "text": "Ulcerative colitis", "correct": false}, {"label": "C", "text": "Carcinoma rectum", "correct": false}, {"label": "D", "text": "Hemorrhoids", "correct": false}], "correct_answer": "A. Crohn’s disease of anorectum", "question_images": ["https://image.prepladder.com/content/2aLe7kC26i0h249PfVzc1739875473.png"], "explanation_images": ["https://image.prepladder.com/content/dwuEbploHORHgpVLOAoB1739875526.png", "https://image.prepladder.com/content/nOHcOinw7kaP1XFLFZei1739875463.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XPAn19JJomtK41aqqga31746108043.mp3", "video": ""}, {"text": "A patient with a history of ulcerative colitis (UC) has undergone a total proctocolectomy with ileal pouch-anal anastomosis (TPA + IPAA) as part of their treatment. Which of the following is not a possible complication of the procedure?", "options": [{"label": "A", "text": "Anastomotic leak", "correct": false}, {"label": "B", "text": "Pouchitis", "correct": false}, {"label": "C", "text": "Pelvic sepsis", "correct": false}, {"label": "D", "text": "Peritonitis", "correct": true}], "correct_answer": "D. Peritonitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/erBYQ2ary24NPqDaF4xI1748938620.mp3", "video": ""}, {"text": "Which of the following procedures is the definitive management of Ulcerative colitis?", "options": [{"label": "A", "text": "Total Proctocolectomy with End Ileostomy(TPA+EI)", "correct": false}, {"label": "B", "text": "Total Proctocolectomy with Ileal Pouch-Anal Anastomosis (TPA+IPAA)", "correct": true}, {"label": "C", "text": "Total Proctocolectomy with mucosectomy with hand-sewn IPAA", "correct": false}, {"label": "D", "text": "Total abdominal colectomy with very low Hartmann closure with end ileostomy", "correct": false}], "correct_answer": "B. Total Proctocolectomy with Ileal Pouch-Anal Anastomosis (TPA+IPAA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NFU5JcxiCifwmJSlQfsn1739875212.png", "https://image.prepladder.com/content/znqGID2A2KBUsZBpVIzX1739875283.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cKlV2ly5IdeXm2FNUnn71748938521.mp3", "video": ""}, {"text": "A 45-year-old patient presents with a history of chronic abdominal pain, frequent bloody diarrhea, and an urgent need to defecate. Colonoscopy reveals continuous inflammation starting from the rectum and extending through the colon. Despite receiving the highest doses of medical therapy, the symptoms have worsened. Which of the following would not be considered an indication for surgery in this patient?", "options": [{"label": "A", "text": "Failure of maximum medical therapy", "correct": false}, {"label": "B", "text": "Multiple bowel movements", "correct": false}, {"label": "C", "text": "Fulminant colitis", "correct": false}, {"label": "D", "text": "Enteroenteric fistula", "correct": true}], "correct_answer": "D. Enteroenteric fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ulcerative colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Crohn’s disease:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Failure of maximum medical therapy <strong>(Option A)</strong></li>\n<li>Poor quality of life due to tenesmus, urgency, and low body weight.</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> movements <strong>(Option B)</strong>, poor nutritional status <strong>(Option D)</strong>, and weak physical health.</li>\n<li>Growth <span class=\"customMeta\" data-dictid=\"680dfbc5a5169277719748281f877e\">retardation</span> in children or adolescents;</li>\n<li>Fulminant <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> <strong>(Option C)</strong>. Some of these cases may also have toxic megacolon.</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> leads to chronic <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> and a dilated colon, both leading to an increased risk of perforation.</li>\n<li>Significant GI bleeding</li>\n<li>Associated <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> cholangitis</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> or cancer in colonoscopic surveillance (chronic UC &gt; 8 years)</li>\n<li>Perianal disease not responding to treatment.</li>\n<li>Severe extra-intestinal disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Children with failure to thrive</li>\n<li>Symptoms of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> secondary to fibrostenosing Crohn's disease</li>\n<li>Perforated Crohn’s disease with associated <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or fistula</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain with obstruction</li>\n<li>Cancer or dysplasia</li>\n<li>Isolated <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> ileal disease</li>\n<li>Recurrent disease</li>\n<li>Incidental finding of Crohn’s during an appendectomy</li>\n</ul>\n<p><br/>\n\t\t\t </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XA82C2z8QlFTrdK3CyPR1748938360.mp3", "video": ""}, {"text": "A 35-year-old patient with moderate to severe ulcerative colitis has achieved clinical remission with a biologic agent. Which of the following drugs is used in the maintenance therapy for moderate to severe ulcerative colitis?", "options": [{"label": "A", "text": "Mesalamine", "correct": false}, {"label": "B", "text": "Adalimumab", "correct": true}, {"label": "C", "text": "Sulfasalazine", "correct": false}, {"label": "D", "text": "Hydrocortisone", "correct": false}], "correct_answer": "B. Adalimumab", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xPZT9Zw0c5XL089Kfqln1739874963.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mild to Moderate UC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Moderate to Severe UC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goals of Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induce and maintain clinical remission.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Achieve and maintain glucocorticoid-free remission, prevent relapse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-ASA compounds (e.g., mesalamine, sulfasalazine) or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> corticosteroids. <strong>(Options A &amp; C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-ASA compounds, corticosteroids <strong>(Option D)</strong>, or biologics (e.g., anti-TNF agents, vedolizumab).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maintenance Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-ASA compounds; consider thiopurines for non-responders or relapsers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biologics (e.g., anti-TNF agents- infliximab, <span class=\"customMeta\" data-dictid=\"53317d3a3016927771807900a04be9\">adalimumab</span> <strong>(Option B)</strong>; vedolizumab), thiopurines, or small molecules (e.g., <span class=\"customMeta\" data-dictid=\"adefe6b2951692777190633c0f12c3\">JAK</span> inhibitors).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lab Monitoring</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CBC, liver tests every 3-4 months; electrolytes and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function annually.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not routinely required unless symptoms persist.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colonoscopy or flexible <span class=\"customMeta\" data-dictid=\"bcae8561fa16927771989814c536d0\">sigmoidoscopy</span> every 6 months, or based on clinical need.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory Markers</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CRP and fecal calprotectin every 3-4 months if used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relapse Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Optimize dosage, consider switching therapies if necessary.</li>\n<li>Evaluate for co-existing conditions and adherence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specific Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thiopurines:</strong> Consider if non-responsive to 5-ASA.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anti-TNF Agents</li>\n<li>Vedolizumab</li>\n<li>Ustekinumab</li>\n<li>Mirikizumab</li>\n<li>JAK Inhibitors (Tofacitinib, Upadacitinib)</li>\n<li>S1P <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Modulators (Ozanimod, Etrasimod)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HCTVTGDR9aLQUaWSFMf51748938104.mp3", "video": ""}, {"text": "A 55-year-old male patient presents with a low rectal tumor and requires bowel diversion. The surgeon is considering the type of stoma to be created. Which of the following indications best matches the need for an ileostomy rather than a colostomy?", "options": [{"label": "A", "text": "To relieve bowel obstruction when resection is not feasible.", "correct": false}, {"label": "B", "text": "To protect a distal anastomosis after low anterior resection.", "correct": false}, {"label": "C", "text": "To manage inflammatory diseases with severe perianal disease.", "correct": false}, {"label": "D", "text": "Permanent fecal diversion following total colectomy", "correct": true}], "correct_answer": "D. Permanent fecal diversion following total colectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zApHTknMefPTEZNLy3yR1739873174.png", "https://image.prepladder.com/content/ZUl9bPTS9QexmkSMOJ9i1739873214.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ileostomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Colostomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically located in the right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> fossa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically located in the left <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stool Consistency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually results in liquid or semi-liquid stool</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces a more formed stool</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ileostomy is usually spouted</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colostomy is usually flush</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To defunction the rest of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> in order to protect a <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> anastomosis</li>\n<li>To evacuate <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> from the body if the entire <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> has been removed (such as in <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer, IBD)</li>\n<li>To relieve <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To protect a <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> or allow <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> away from the faecal flow</li>\n<li>Following <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> when <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> is unsafe or not possible</li>\n<li>To relieve <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> when <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is not feasible</li>\n<li>To reduce disease activity (e.g. Crohn’s disease)</li>\n<li>To allow alternative <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> control (incontinence)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> problems</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More likely</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less likely</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appliances</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires bags that often need to be emptied frequently due to the liquid <span class=\"customMeta\" data-dictid=\"bb67ce71481692777185f0e078535f\">consistency</span> of the stool</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses appliances that may be changed as needed, depending on the type of <span class=\"customMeta\" data-dictid=\"5c7cf73673169277718428b84f7488\">colostomy</span> and <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> consistency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"BruceBlaus\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ileostomy.png\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/zApHTknMefPTEZNLy3yR1739873174.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"BruceBlaus\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Blausen_0247_Colostomy.png\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/ZUl9bPTS9QexmkSMOJ9i1739873214.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/87wojDrzslCm2Yr6WkNs1748930426.mp3", "video": ""}, {"text": "A 39-year-old male with a 12-year history of ulcerative colitis presents with worsening symptoms despite maximum medical therapy. He experiences &amp;gt;10 bowel movements per day, urgency, tenesmus, and significant weight loss. Biopsies show high-grade dysplasia. The surgical team plans a total proctocolectomy with ileal pouch-anal anastomosis (IPAA). What is the primary goal of the planned surgery for this patient?", "options": [{"label": "A", "text": "Palliative", "correct": false}, {"label": "B", "text": "Curative", "correct": true}, {"label": "C", "text": "Remission", "correct": false}, {"label": "D", "text": "Maintenance", "correct": false}], "correct_answer": "B. Curative", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bYgUmBaPnQnpT4XYoDX31748937872.mp3", "video": ""}, {"text": "Which of the following statements regarding ulcerative colitis is correct?", "options": [{"label": "A", "text": "Backwash ileitis, where there is secondary inflammation in the terminal ileum, is a common finding in all patients with ulcerative colitis.", "correct": false}, {"label": "B", "text": "Extraintestinal manifestations such as arthritis are more likely to occur in patients with proctitis alone.", "correct": false}, {"label": "C", "text": "8 bloody stools per day and associated joint pain are classified as moderate ulcerative colitis.", "correct": false}, {"label": "D", "text": "Fulminant ulcerative colitis is characterized by &amp;gt;10 bowel movements daily, continuous bleeding, and evidence of systemic toxicity.", "correct": true}], "correct_answer": "D. Fulminant ulcerative colitis is characterized by &gt;10 bowel movements daily, continuous bleeding, and evidence of systemic toxicity.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Stool Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Systemic Symptoms and signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;4 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> signs of toxicity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;4 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, Elevated ESR, CRP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;6 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, tachycardia, anemia, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> illness, hypoalbuminuria, Elevated ESR, CRP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fulminant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous bleeding, fever, tachycardia, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> &amp; distension, “Toxic megacolon” (progressive <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> dilation, an indication for emergency surgery) in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VDKA3CC43wM7YPTGCUfR1748937031.mp3", "video": ""}, {"text": "A 38-year-old patient with a history of chronic diarrhea and rectal bleeding undergoes a barium enema for evaluation. The radiological image shows changes in the colonic mucosa. Based on the findings of the barium enema, which of the following radiological features is most indicative of Ulcerative colitis (UC)?", "options": [{"label": "A", "text": "Narrowed, constricted colon with a \"hose pipe\" appearance", "correct": true}, {"label": "B", "text": "Multiple deep ulcers with surrounding inflammation", "correct": false}, {"label": "C", "text": "Discontinuous patches of inflammation with normal segments in between", "correct": false}, {"label": "D", "text": "Presence of pseudopolyps", "correct": false}], "correct_answer": "A. Narrowed, constricted colon with a \"hose pipe\" appearance", "question_images": ["https://image.prepladder.com/content/AJ4zfLDoY2ZcxwPNVV8M1739874559.png"], "explanation_images": ["https://image.prepladder.com/content/8d50A8GvnobMUUIDmxrU1739874596.png", "https://image.prepladder.com/content/bUqkdkY0iztUFJBSdUBf1739874640.png", "https://image.prepladder.com/content/PdTZGJzaTMXVJk05a9Aw1739874674.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/n9SmFrlibggNNmWNu6Jq1748936632.mp3", "video": ""}, {"text": "A 30-year-old patient presents with persistent and worsening chronic diarrhea, rectal bleeding, and abdominal pain for the past several months. An endoscopic examination reveals continuous mucosal inflammation starting at the rectum and extending proximally. Which of the following findings is most characteristic of ulcerative colitis (UC) and helps differentiate it from Crohn's disease?", "options": [{"label": "A", "text": "Patchy inflammation with skip lesions", "correct": false}, {"label": "B", "text": "Continuous inflammation starting from the rectum", "correct": true}, {"label": "C", "text": "Transmural inflammation with cobblestone appearance", "correct": false}, {"label": "D", "text": "Presence of granulomas in the mucosal layer", "correct": false}], "correct_answer": "B. Continuous inflammation starting from the rectum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Contributing factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Defective <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> production: Mucosal <span class=\"customMeta\" data-dictid=\"6eec2212b91692777189b54f3d9066\">immunological</span> reactions</li>\n<li>Autoimmune factors (Cytotoxic T cells, anticolon antibodies)</li>\n<li>HLA DR2 association</li>\n<li>Family history</li>\n<li>Cow's milk allergy</li>\n<li>Stress and lifestyle associations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Protective factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Appendicectomy</li>\n<li>Smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sites of involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>UC is confined to the large intestine.</li>\n<li>Always involves the rectum; extends proximally continuously.</li>\n<li>Extent of involvement:\n\t\t\t\t<ul>\n<li>Proctitis/Proctosigmoiditis (Limited to the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon)</li>\n<li>Left-Sided Colitis</li>\n<li>Pancolitis (Entire colon)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Colonoscopy Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Continuous <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> from the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> line of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and extends proximally.</li>\n<li>Initially, <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> appears erythematous, granular, or roughened; it worsens over time.</li>\n<li>Ulcers are long, serpentine, covered in fibrin, with a \"bear claw\" appearance.</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> can occur due to <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> into blood vessels.</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Microscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Inflammation limited to the mucosal layer</li>\n<li>Polymorphonuclear leukocytes in <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria.</li>\n<li>Depletion of <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> in goblet cells.</li>\n<li>Crypt abscesses contain <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells within Lieberkühn crypts.</li>\n<li>No granulomas, deep <span class=\"customMeta\" data-dictid=\"2abcb5c50b1692777202f9e11f60f4\">fissural</span> ulcers, or <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> aggregates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/amwJzjR4aHh4buVf5Tcl1748936483.mp3", "video": ""}, {"text": "Which extraintestinal manifestation is most commonly associated with Crohn's disease?", "options": [{"label": "A", "text": "Uveitis", "correct": false}, {"label": "B", "text": "Pyoderma gangrenosum", "correct": false}, {"label": "C", "text": "Erythema nodosum", "correct": true}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "C. Erythema nodosum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:554px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Skin </strong></p>\n<ul>\n<li>Erythema nodosum</li>\n<li>Erythema multiforme</li>\n<li>Pyoderma gangrenosum</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Eyes </strong></p>\n<ul>\n<li>Iritis</li>\n<li>Uveitis</li>\n<li>Conjunctivitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Blood </strong></p>\n<ul>\n<li>Anemia</li>\n<li>Thrombocytosis</li>\n<li>Phlebothrombosis</li>\n<li>Arterial thrombosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. Joints </strong></p>\n<ul>\n<li>Peripheral Arthritis</li>\n<li>Ankylosing spondylitis</li>\n<li>Sacroiliitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5. Liver </strong></p>\n<ul>\n<li>Non-specific Hepatitis</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> cholangitis</li>\n<li>Cholesterol gallstones</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6. <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> </strong></p>\n<ul>\n<li>Nephrotic syndrome <strong>(Rare)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>7. Urological </strong></p>\n<ul>\n<li>Stones (Most common type: <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">Oxalate</span> stones)</li>\n<li>Ureteral obstruction</li>\n<li>Entero-vesical fistula</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>8. <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">Pancreas</span> </strong></p>\n<ul>\n<li>Pancreatitis <strong>(Rare)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>9. <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">Amyloidosis</span> (Rare)</strong></p>\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> manifestation of <span class=\"customMeta\" data-dictid=\"5eddae989e1692777189a59921cc61\">IBD</span> - <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">Erythema</span> Nodosum</li>\n<li>Erythema Nodosum\n\t\t\t\t<ol>\n<li>Most responsive for Rx of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</li>\n<li>Persistence of <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">Erythema</span> Nodosum - Indicates inadequate control of IBD</li>\n</ol>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:455px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Extraintestinal Manifestations - Affects about 30% of patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Skin Lesions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Erythema nodosum, <span class=\"customMeta\" data-dictid=\"089ef1b1bf169277719626559c2930\">pyoderma</span> gangrenosum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Joint Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Arthritis, arthralgias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eye Inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Uveitis, iritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Liver Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hepatitis, pericholangitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mouth Sores</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Aphthous stomatitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other (Rare)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Amyloidosis, pancreatitis, <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ptMOBPCwU71k0EYGUuMC1748932979.mp3", "video": ""}, {"text": "A 45-year-old patient with a history of long-standing Crohn's disease presents for a follow-up examination. An abdominal X-ray with barium contrast is performed to evaluate the current state of the small bowel. Based on the barium radiographic image provided, which of the following signs is depicted below?", "options": [{"label": "A", "text": "String Sign of Kantor", "correct": true}, {"label": "B", "text": "Apple-Core Sign", "correct": false}, {"label": "C", "text": "Lead-Pipe Appearance", "correct": false}, {"label": "D", "text": "Bird-Beak Sign", "correct": false}], "correct_answer": "A. String Sign of Kantor", "question_images": ["https://image.prepladder.com/content/fKemIqTQ7N57ahmc5Ibk1739874042.png"], "explanation_images": ["https://image.prepladder.com/content/aw3YOCiiznvkEEurKe3P1739874082.png", "https://image.prepladder.com/content/pGGjKu9iKAleepxdTg0C1739874116.png", "https://image.prepladder.com/content/mGB7cnoNAU8489P4Uv461739874153.png", "https://image.prepladder.com/content/AFhPtpU6ngvSiEqaPpWl1739874236.png", "https://image.prepladder.com/content/pDNOfOjO7ryTaMIS7QKN1739874271.png", "https://image.prepladder.com/content/HIAZL618jkht8jbA1fUd1739874313.png", "https://image.prepladder.com/content/qeK2sfOCiOvhgrSEGglm1739874344.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:541px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Radiological signs of Crohn’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>String sign of Kantor</strong></p>\n<p>Cicatrization of the ileum, which is a narrowing of the <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> caused by scarring.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ian Bickle\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/string-sign-of-kantour-crohn-disease\" data-tags=\"\" height=\"450\" src=\"https://image.prepladder.com/content/aw3YOCiiznvkEEurKe3P1739874082.png\" width=\"450\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fat <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> sign: </strong>Low <span class=\"customMeta\" data-dictid=\"22818451b71692777182237914a233\">attenuation</span> of <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> fat around the bowel</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/fat-halo-sign-1\" data-tags=\"\" height=\"343\" src=\"https://image.prepladder.com/content/pGGjKu9iKAleepxdTg0C1739874116.png\" width=\"450\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rose thorn or <span class=\"customMeta\" data-dictid=\"24239962981692777197a1105f8845\">raspberry</span> thorn appearance:</strong> <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">Linear</span> <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> ulcers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"http://www.svuhradiology.ie/case-study/crohn-disease-rosethorn-ulcers/\" data-tags=\"\" height=\"482\" src=\"https://image.prepladder.com/content/mGB7cnoNAU8489P4Uv461739874153.png\" width=\"450\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vascular jejunization of ileum:</strong> Comb sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mang, T. &amp; Scharitzer, Martina.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Abb-13-8-Comb-sign-Das-KontrastmittelKM-verstaerkte-axiale-CT-eines-Patienten-mit-M_fig2_323968819\" data-tags=\"\" height=\"699\" src=\"https://image.prepladder.com/content/AFhPtpU6ngvSiEqaPpWl1739874236.png\" width=\"450\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/63ctn41wJ4JZYMEmHxFa1748932797.mp3", "video": ""}, {"text": "A 34-year-old female with a known diagnosis of Crohn's disease presents with symptoms of abdominal pain, weight loss, and intermittent diarrhea. Imaging studies reveal significant inflammation and strictures in the gastrointestinal tract. Which part of the gastrointestinal tract is most commonly affected by Crohn's disease, leading to ulcers and strictures?", "options": [{"label": "A", "text": "Duodenum", "correct": false}, {"label": "B", "text": "Jejunum", "correct": false}, {"label": "C", "text": "Ileum", "correct": true}, {"label": "D", "text": "Colon", "correct": false}], "correct_answer": "C. Ileum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:525px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Acute inflammation, oedema, chronic fibrotic lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Perforation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>This leads to fistulas, localised abscesses, and rarely generalised peritonitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Toxic Megacolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Colonic dilation, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> tenderness, fever, leukocytosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chronic, indolent, possible massive <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> with duodenal involvement</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:534px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cancer Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk Factors and Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic mucosal inflammation, higher relative risk</p>\n<p>M/c site in the small intestine: <strong>Ileum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated risk with prolonged disease, <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> precursor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> Adenocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive, with high <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> mucin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extraintestinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Squamous cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (vulva, anal canal), Hodgkin and non-Hodgkin lymphomas, increased with immunomodulators</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ODzLOKeWCSsmade0djuS1748932687.mp3", "video": ""}, {"text": "A 35-year-old patient presents with chronic diarrhea, abdominal pain, and weight loss. A resection of the terminal ileum is performed, and the findings are shown in the image below. Which of the following findings is most characteristic of this disease?", "options": [{"label": "A", "text": "Continuous mucosal lesions and crypt abscesses", "correct": false}, {"label": "B", "text": "Cobblestone appearance and transmural inflammation", "correct": true}, {"label": "C", "text": "Superficial ulceration and loss of haustrations", "correct": false}, {"label": "D", "text": "Pseudopolyps and mucosal inflammation", "correct": false}], "correct_answer": "B. Cobblestone appearance and transmural inflammation", "question_images": ["https://image.prepladder.com/content/8O1PuIz1gzscKzMG0y0e1739873524.png"], "explanation_images": ["https://image.prepladder.com/content/WkOJbiU9XnTiI1h5UDeo1739873578.png", "https://image.prepladder.com/content/PNZxRugsMhTSwW4guAIh1739873681.png", "https://image.prepladder.com/content/uz68kFwR9Cp8fU77Ykbt1739873620.png", "https://image.prepladder.com/content/1KYxOK6573tNF6Wx5VQm1739873652.png", "https://image.prepladder.com/content/6nAvhTP0y3ama3nXD3701739873767.png", "https://image.prepladder.com/content/uoFhlyVMgEIPTYifmTUl1739873782.png", "https://image.prepladder.com/content/gRTAmMObWYaU1tTcWRGh1739873850.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Crohn's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ulcerative Colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Skip lesions</strong>: Involves <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> and colon</li>\n<li><strong>Cobblestone appearance</strong>: <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">Transmural</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> results in cobblestone mucosa</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"PPSE15\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ResectedIleum.jpg\" data-tags=\"\" height=\"212\" src=\"https://image.prepladder.com/content/WkOJbiU9XnTiI1h5UDeo1739873578.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Continuous lesions</strong>: Affects <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> in continuous manner starting from rectum</li>\n<li><strong>Presence of pseudopolyps</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"DeRoche, Tom &amp; Yuan, Xiao &amp; Liu, Xiuli. \" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Gross-photograph-of-ulcerative-colitis-Diffuse-erythema-edema-and-many-inflammatory_fig1_263291122\" data-tags=\"\" height=\"376\" src=\"https://image.prepladder.com/content/PNZxRugsMhTSwW4guAIh1739873681.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmural inflammation</strong>: Involves all layers of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Crohn%27s_disease_-_colon_-_very_high_mag.jpg\" data-tags=\"\" height=\"746\" src=\"https://image.prepladder.com/content/uz68kFwR9Cp8fU77Ykbt1739873620.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p><strong>Non-caseating granulomas</strong>: Characteristic finding</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:CD_Granuloma.jpg\" data-tags=\"\" height=\"578\" src=\"https://image.prepladder.com/content/1KYxOK6573tNF6Wx5VQm1739873652.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucosal inflammation</strong>: Confined to <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and submucosa</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/6nAvhTP0y3ama3nXD3701739873767.png\" width=\"500\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Crypt abscesses</strong>: <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">Neutrophil</span> <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> into crypts</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Moderate_chronic_active_ulcerative_colitis,_very_high_mag.jpg\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/uoFhlyVMgEIPTYifmTUl1739873782.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/skSCNLeRmjJGBSs4D2dt1748932402.mp3", "video": ""}, {"text": "A 40-year-old male presents with chronic diarrhea, abdominal pain, and recent weight loss. On examination, there is tenderness in the right lower quadrant, and a colonoscopy revealed patchy inflammation in the terminal ileum with skip lesions. Which of the following combinations of risk factors and etiological factors is most consistent with the diagnosis?", "options": [{"label": "A", "text": "NOD2/CARD15 gene mutation, smoking", "correct": true}, {"label": "B", "text": "HLA-DR2 association, appendectomy", "correct": false}, {"label": "C", "text": "Autoimmune etiology, non-smoker", "correct": false}, {"label": "D", "text": "Milk allergy, personality disorders", "correct": false}], "correct_answer": "A. NOD2/CARD15 gene mutation, smoking", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Crohn’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ulcerative Colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NOD2/CARD15 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16 <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HLA-DR2 association <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Smoking</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protective effect, lowers risk <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly refined food, food additives, particularly preservatives</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Westernized diet, red meat, milk <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">allergy</span> <strong>(Option D)</strong>.</p>\n<p>Less common in vegetarians.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoimmune Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial <span class=\"customMeta\" data-dictid=\"73bb5b9ea91692777186234a83fc37\">dysbiosis</span> with aggressive T cell <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to specific components of intestinal microbes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytotoxic <span class=\"customMeta\" data-dictid=\"9f1d97eb2b1692777200b3926afd54\">T lymphocytes</span> against <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">Colonic</span> epithelial cells and the presence of anticolon antibodies. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appendectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No clear association <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protective</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mycobacterium infection, high levels of <span class=\"customMeta\" data-dictid=\"18aafee1a71692777198cdc688e8aa\">sanitation</span> in childhood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stress, personality disorders <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> association, 10% of first-degree relatives and 50% of <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Familial tendency present, less frequent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/r2PfgK9L4pXys0qe4bBu1748930722.mp3", "video": ""}, {"text": "A 65-year-old woman undergoes an emergency ileostomy following bowel obstruction. Two weeks postoperatively, she presents with increased pain and swelling around the stoma site. On examination, a bulge is noted adjacent to the stoma. The stoma itself appears healthy, with no signs of necrosis or ischemia. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Stoma Stenosis", "correct": false}, {"label": "B", "text": "Stoma Retraction", "correct": false}, {"label": "C", "text": "Parastomal Hernia", "correct": true}, {"label": "D", "text": "Stoma Prolapse", "correct": false}], "correct_answer": "C. Parastomal Hernia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stoma Ischemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lack of blood supply causing <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> discoloration and necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs early post-op (within days), Discolored</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stoma <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">Prolapse</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> of the <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> through the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrusion, more common in loop stomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stoma <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">Retraction</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stoma sinks below skin level; often leads to poor <span class=\"customMeta\" data-dictid=\"b9fb3fb6ed1692777181187adf0bad\">appliance</span> fit and skin irritation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concave surface, skin irritation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parastomal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Herniation of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents through the <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> opening</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bulging adjacent to the stoma, discomfort</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stoma <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrowing of stoma, leading to obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrowed opening, <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin Irritation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irritation or <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of skin around the <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> due to <span class=\"customMeta\" data-dictid=\"b9fb3fb6ed1692777181187adf0bad\">appliance</span> use</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor <span class=\"customMeta\" data-dictid=\"b9fb3fb6ed1692777181187adf0bad\">appliance</span> fitting, leakage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May occur due to trauma or mucosal irritation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma, irritation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fistulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> connections between the <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> and other organs or skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tfWdB4VednSllpim1iV61748930590.mp3", "video": ""}, {"text": "A 55-year-old male patient undergoes emergency abdominal surgery for a perforated sigmoid diverticulitis with peritonitis. The surgeon decides to create a stoma as part of the management plan. Which of the following stomas is most appropriate for diverting fecal content and allowing distal bowel healing while planning for potential future reconnection?", "options": [{"label": "A", "text": "End colostomy", "correct": false}, {"label": "B", "text": "Loop ileostomy", "correct": true}, {"label": "C", "text": "Double-barrel colostomy", "correct": false}, {"label": "D", "text": "Permanent ileostomy", "correct": false}], "correct_answer": "B. Loop ileostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/52fS8w36IUa8DaesKX7G1739873296.png", "https://image.prepladder.com/content/48406z9uehxR0Is4Go351739873312.png", "https://image.prepladder.com/content/k7W68qghzxGo0BKYQw2B1739873324.png", "https://image.prepladder.com/content/Od2iZgocYM3TsoXkRYxe1739873336.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:1096px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reversibility</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>End Colostomy</strong><strong> (Option A)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/52fS8w36IUa8DaesKX7G1739873296.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single opening from the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> bowel. Often permanent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used when the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is removed or left in place, e.g., Hartmann's procedure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often permanent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loop <span class=\"customMeta\" data-dictid=\"fd21e4e7c116927771898e2055e14b\">Ileostomy</span> </strong><strong>(Option B)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/48406z9uehxR0Is4Go351739873312.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loop of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is brought to the surface, and an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> is made</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary diversion, especially in emergencies, and easily reversible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Double-barrel <span class=\"customMeta\" data-dictid=\"5c7cf73673169277718428b84f7488\">Colostomy</span> </strong></p>\n<p><strong>(Option C)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/k7W68qghzxGo0BKYQw2B1739873324.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two stomas are created: one for faecal output and one for <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> discharge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely used; can be for cases requiring both <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and exteriorization, offering <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Permanent Ileostomy</strong><strong> </strong></p>\n<p><strong>(Option D)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/Od2iZgocYM3TsoXkRYxe1739873336.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminal <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> is brought to the surface after a colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used when reconnection is not planned, often after total <span class=\"customMeta\" data-dictid=\"da1e89cf561692777196c1c93d4549\">proctocolectomy</span> for conditions like FAP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/l5c42GBzi2xebFKSrOfC1745397172.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 34 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements regarding intraoperative findings for treatment of large bowel obstruction is incorrect?", "options": [{"label": "A", "text": "A distended caecum during laparotomy indicates a large bowel obstruction.", "correct": false}, {"label": "B", "text": "Emergency caecostomy can be done to stabilize the patient.", "correct": false}, {"label": "C", "text": "A collapsed caecum during laparotomy suggests a large bowel obstruction.", "correct": true}, {"label": "D", "text": "Resection and anastomosis are appropriate treatments for Crohn's disease", "correct": false}], "correct_answer": "C. A collapsed caecum during laparotomy suggests a large bowel obstruction.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WlIxEYfOV2ICcgjaEl3A1745410064.mp3", "video": ""}, {"text": "A 45-year-old patient with a history of previous abdominal surgeries presents with severe abdominal pain that initially started as crampy but has become constant and steady. The patient has a temperature of 102 degrees, 128 beats per minute heart rate, and elevated white blood cell count. Which diagnostic test is most appropriate for confirming in this patient?", "options": [{"label": "A", "text": "Abdominal X-ray", "correct": false}, {"label": "B", "text": "CECT", "correct": true}, {"label": "C", "text": "USG abdomen", "correct": false}, {"label": "D", "text": "MRI abdomen", "correct": false}], "correct_answer": "B. CECT", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strangulating Obstruction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with intact blood supply.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with compromised blood supply.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crampy, colicky pain.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constant, steady pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically absent or mild.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, tachycardia, and elevated <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> count.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> (initial assessment).</p>\n<p><strong>Contrast-Enhanced CT (CECT).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast-Enhanced CT (CECT)</strong> for detailed evaluation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually no <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> signs of infection or inflammation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic signs of infection (e.g., fever) and inflammation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be managed with <span class=\"customMeta\" data-dictid=\"c65831e9cb1692777185d546421397\">conservative treatment</span> or surgery if necessary.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Requires urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention to address <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and restore blood flow</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/euIzrPf3R19u6UVrP2qn1745410247.mp3", "video": ""}, {"text": "A 55-year-old female patient presents with a history of abdominal surgery performed 3 days ago. She reports worsening abdominal distension and has not passed stool since the surgery. On examination her abdomen is distended, and bowel sounds are absent. Which of the following statements is correct regarding this condition?", "options": [{"label": "A", "text": "Caused by increased peristaltic activity.", "correct": false}, {"label": "B", "text": "Surgery is the first-line treatment.", "correct": false}, {"label": "C", "text": "X-ray shows dilated bowel loops and air-fluid levels", "correct": true}, {"label": "D", "text": "Associated with hyperkalemia.", "correct": false}], "correct_answer": "C. X-ray shows dilated bowel loops and air-fluid levels", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LkCXCDrI5YdoI0TE0ckS1739936432.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal surgery.</li>\n<li>Uremia.</li>\n<li>Mesenteric ischemia.</li>\n<li>Retroperitoneal hematoma.</li>\n<li>Intra-abdominal sepsis.</li>\n<li>Dyselectrolytemia (e.g., hypokalemia)<strong> (Option D).</strong></li>\n<li>Drugs affecting intestinal motility:\n\t\t\t\t<ul>\n<li>Opiates.</li>\n<li>Antipsychotics.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurogenic- <span class=\"customMeta\" data-dictid=\"85c304623c1692777187da4d1f1ee7\">enteric</span> nervous system and CNS</li>\n<li>Inflammatory- histamine, IL-6 and IL-8, monocytes and macrophages</li>\n<li>Enteric hormones and neuropeptides- motilin, substance P, and <span class=\"customMeta\" data-dictid=\"1059a0d9031692777201a8d8debd5e\">vasoactive</span> intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> [VIP]</li>\n<li>Perioperative <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> disturbances</li>\n<li>Opioids</li>\n<li>Duration of surgery and extent of <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> trauma</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/LkCXCDrI5YdoI0TE0ckS1739936432.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal distension.</li>\n<li>Abdominal discomfort.</li>\n<li><strong>Non-colicky pain.</strong></li>\n<li>Vomiting.</li>\n<li>Non-passage of <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> and flatus.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IOC: </strong>Abdominal X-ray. <strong>(Option C)</strong></p>\n<p><strong>Findings:</strong></p>\n<ul>\n<li>Dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n<li>Gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum.</li>\n<li>Multiple air-fluid levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decompression: </strong>Nasogastric aspiration.</p>\n\t\t\t \n\n\t\t\t<p><strong>Diet: </strong>Restrict oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> until <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> sounds return or the patient starts passing <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> and flatus.</p>\n\t\t\t \n\n\t\t\t<p><strong>Treatment of Underlying Cause:</strong></p>\n<ul>\n<li>Correct dyselectrolytemia (e.g., hypokalemia).</li>\n<li>Discontinue medications affecting <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> (e.g., opiates).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/py5xToVPOljG6IVMqwao1745410447.mp3", "video": ""}, {"text": "A 4-year-old boy is brought with intermittent episodes of severe abdominal pain, during which he pulls his knees to his chest and cries inconsolably. He passed a small amount of \"red, jelly-like\" stool. On examination, the child appears pale, lethargic, and mildly dehydrated. What is the most likely abdominal CT finding seen in this condition?", "options": [{"label": "A", "text": "Target sign", "correct": true}, {"label": "B", "text": "Claw sign", "correct": false}, {"label": "C", "text": "Coiled spring sign", "correct": false}, {"label": "D", "text": "Coffee bean sign", "correct": false}], "correct_answer": "A. Target sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aQPQTX0ea5RkISgzBmVS1739936560.png", "https://image.prepladder.com/content/5MazT5OGvbAqllKxVDj01739936598.png", "https://image.prepladder.com/content/r1fiQGGKxmQA38GwzCxB1739936666.png", "https://image.prepladder.com/content/zdM8wAQHdI58JvJhPNPJ1739936725.png", "https://image.prepladder.com/content/W6e1s22Vj7jnBygV3ix01739936785.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tYaN68ne0zSCbxE7IVZT1745410652.mp3", "video": ""}, {"text": "A 75-year-old male patient, bedridden after hip surgery, presents with a 4-day history of progressive abdominal distension, nausea, and constipation. On physical examination, his abdomen is distended but non-tender, with decreased bowel sounds. An abdominal X-ray shows dilated loops of colon, particularly in the cecum, but no air-fluid levels or evidence of mechanical obstruction. His vital signs are stable, and there is no fever. Which of the following drugs is commonly used in pharmacologic treatment of this condition?", "options": [{"label": "A", "text": "Loperamide", "correct": false}, {"label": "B", "text": "Neostigmine", "correct": true}, {"label": "C", "text": "Stimulant laxatives", "correct": false}, {"label": "D", "text": "Osmotic laxatives", "correct": false}], "correct_answer": "B. Neostigmine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zVlam6qsXmRrvNRghTRr1739936895.png", "https://image.prepladder.com/content/t8ZJ9cZnh3BsgmRchv2E1739936963.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/G5VxqCNpcvyluwiSMyG11745410893.mp3", "video": ""}, {"text": "A 72-year-old male presents with a 2-day history of progressive abdominal distension, constipation, and colicky pain. He has a history of chronic constipation and has been bedridden for the past few months due to a hip fracture. On examination, his abdomen is distended and tympanic, with mild tenderness. Abdominal guarding and rigidity not observed. X-ray of the abdomen is shown below. Which of the following factors does not predispose to this condition?", "options": [{"label": "A", "text": "Chronic constipation with laxative abuse", "correct": false}, {"label": "B", "text": "Anticholinergic drugs", "correct": false}, {"label": "C", "text": "Mentally-retarded individuals", "correct": false}, {"label": "D", "text": "Short pelvic mesocolon", "correct": true}], "correct_answer": "D. Short pelvic mesocolon", "question_images": ["https://image.prepladder.com/content/1NK1CPVoF28HOCJ1od9L1739937063.png"], "explanation_images": ["https://image.prepladder.com/content/URhqEyVHqeolKRmgsb8R1739937137.png", "https://image.prepladder.com/content/HwwvuZjYoMFAAFlS4ZNC1739937188.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoidoscopic derotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial treatment for <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> volvulus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoidopexy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevention of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in non-emergent cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elective <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevention of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in patients with <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> volvulus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hartmann’s procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cases of <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> or perforation(peritonitis)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/c5ffVWzwydGZpuJfrthv1745411179.mp3", "video": ""}, {"text": "Which of the following options is not true regarding caecal volvulus?", "options": [{"label": "A", "text": "Rotation is more commonly seen in clockwise direction", "correct": false}, {"label": "B", "text": "Caecal volvulus involves the terminal ileum and the right colon", "correct": false}, {"label": "C", "text": "In caecal bascule, there is axial twisting", "correct": true}, {"label": "D", "text": "Clinically, it may manifest as small bowel obstruction", "correct": false}], "correct_answer": "C. In caecal bascule, there is axial twisting", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XfCzjjNlJUG2zEwtgVKH1739937344.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MEnQkwRB4nbqm7mTtjp61745411494.mp3", "video": ""}, {"text": "Which of the following is/are components of Hartmann’s procedure?", "options": [{"label": "A", "text": "Sigmoidectomy", "correct": false}, {"label": "B", "text": "Closure of rectal stump", "correct": false}, {"label": "C", "text": "Descending colostomy", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CQa2t17sG3opaTgd5oa91739937411.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cAqlZtGXT89CmRlW2NDq1745411634.mp3", "video": ""}, {"text": "A 45-year-old man with a history of abdominal surgery presents with severe crampy abdominal pain and bilious vomiting. On examination, his abdomen is distended, and he has not had a bowel movement for three days. Which of the following is the most likely cause of his obstruction?", "options": [{"label": "A", "text": "Pelvic Adhesions", "correct": true}, {"label": "B", "text": "Colorectal Cancer", "correct": false}, {"label": "C", "text": "Inguinal Hernia", "correct": false}, {"label": "D", "text": "Crohn's Disease", "correct": false}], "correct_answer": "A. Pelvic Adhesions", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:542px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adhesions<strong> (Option A)</strong> <strong>(Most common)</strong></li>\n<li>Malignancy</li>\n<li>Metastasis</li>\n<li>Peritoneal carcinomatosis</li>\n<li>Hernia</li>\n<li>Crohn's Disease</li>\n<li>Tb</li>\n<li>PID</li>\n<li>Post radiotherapy</li>\n<li>Cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgeries with High Risk of <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (SBO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pelvic surgeries (Highest risk)</strong></li>\n<li>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancies Responsible for SBO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metastasis</li>\n<li>Peritoneal carcinomatosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IWfho05tpb31x0oybamJ1745409497.mp3", "video": ""}, {"text": "A 50-year-old man presents with acute abdominal pain, and bilious vomiting. Physical examination reveals a distended abdomen, and he has not had a bowel movement for three days. An abdominal X-ray is shown below. What is the most appropriate next step in management ?", "options": [{"label": "A", "text": "Administer oral laxatives", "correct": false}, {"label": "B", "text": "Start IV fluids (RL)", "correct": true}, {"label": "C", "text": "Exploratory laparotomy", "correct": false}, {"label": "D", "text": "IV Prokinetics", "correct": false}], "correct_answer": "B. Start IV fluids (RL)", "question_images": ["https://image.prepladder.com/content/lNcTZMFArUlz3gk0kYrT1739935967.png"], "explanation_images": ["https://image.prepladder.com/content/b8Bggg3l8TzwG1OJGpLS1739936052.png", "https://image.prepladder.com/content/Uri3azgM3T8FO7RVskRA1739936128.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jejunum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plicae circulares or <span class=\"customMeta\" data-dictid=\"775b64181b1692777201c6ab88b10e\">valvulae</span> conniventes</strong></p>\n<ul>\n<li>Visible as circumferential, ring-like patterns.</li>\n<li>Multiple dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n<li>Loops are centrally located.</li>\n<li>The mucosal pattern appears well-defined with a “feathery” appearance due to the <span class=\"customMeta\" data-dictid=\"33864cf9a5169277719571e0fdfb61\">plicae</span> circulares.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ileum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</strong></p>\n<ul>\n<li>Loops are centrally located.</li>\n<li>Featureless or “characteristically characterless” appearance, lacking the pronounced mucosal pattern seen in the jejunum.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Kq1skTaurtv48hxO4KbD1745409682.mp3", "video": ""}, {"text": "Based on the findings visible in the X-ray, all of the following are true, except:", "options": [{"label": "A", "text": "Haustral folds are irregularly spaced and do not span the full diameter", "correct": false}, {"label": "B", "text": "Supine view shows centrally positioned dilated bowel loops without haustrations", "correct": true}, {"label": "C", "text": "Upright view reveals multiple air-fluid levels in a step ladder pattern", "correct": false}, {"label": "D", "text": "Haustral folds lack indentations opposite one another", "correct": false}], "correct_answer": "B. Supine view shows centrally positioned dilated bowel loops without haustrations", "question_images": ["https://image.prepladder.com/content/bpi4b1axrUC78yj9GeW21739936232.png"], "explanation_images": ["https://image.prepladder.com/content/yNjUMTyWK20Oq3Q2Wb9D1739936291.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gUwWpNaqAqKf6TsD60vt1745409894.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements about diverticulitis is incorrect? Diverticulitis often presents with abdominal pain localized to the lower left side. A barium enema is a preferred imaging method for diagnosing diverticulitis. Colostomy is often performed as a first-line treatment. Stage Ib of the Modified Hinchey Classification refers to a pericolic abscess. Complications of diverticulitis may include fistula formation, such as colovesical fistula.", "options": [{"label": "A", "text": "1 and 5", "correct": false}, {"label": "B", "text": "2 and 4", "correct": false}, {"label": "C", "text": "4 and 5", "correct": false}, {"label": "D", "text": "2 and 3", "correct": true}], "correct_answer": "D. 2 and 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation or infection of <span class=\"customMeta\" data-dictid=\"c9f59a135316927771862d79e1f59b\">diverticula</span> in the colon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstruction (fecal matter or food): Trapped fecal matter or food causes pressure and inflammation.</li>\n<li>Bacterial infection: Infection occurs when bacteria <span class=\"customMeta\" data-dictid=\"986d4f70531692777196806b9cb494\">proliferate</span> in obstructed diverticula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased pressure from trapped fecal matter can lead to inflammation, infection, and sometimes <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> of the diverticula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal pain (lower left side) <strong>(Statement 1 ruled out)</strong></li>\n<li>Fever</li>\n<li>Nausea, vomiting</li>\n<li>Change in <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits (diarrhea or constipation)</li>\n<li>Tenderness on examination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT Scan (IOC):</strong> Preferred for detailed <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> of the colon, identifying <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and abscesses.</li>\n<li><strong>Ultrasound:</strong> Can detect <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and abscesses, but less detailed than CT.</li>\n<li><strong>Blood Tests:</strong> Elevated white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> suggests infection or inflammation.</li>\n<li><strong>Barium <span class=\"customMeta\" data-dictid=\"981cb55fe1169277718759ac720c5d\">Enema</span> (contraindicated) (Statement 2): </strong>Should be avoided as it can worsen symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics</li>\n<li>Pain management (analgesics)</li>\n<li>Dietary modifications (clear liquids, then low-fiber, high-fiber)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Surgery </strong>(for severe cases or complications)</p>\n<ul>\n<li><strong>Resection:</strong> Removal of the affected segment of the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> to treat severe <span class=\"customMeta\" data-dictid=\"c8de4db86c16927771862eeef04df3\">diverticulitis</span> or complications.</li>\n<li><strong>Colostomy (Statement 3)</strong>: Creation of an <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> opening for waste elimination, often used in severe cases.</li>\n<li><strong>Drainage of Abscesses:</strong> <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> methods to drain abscesses associated with diverticulitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Hinchey <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> (Severity of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> diverticulitis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stage 0: Mild diverticulitis</li>\n<li>Stage I:\n\t\t\t\t<ul>\n<li>Ia: <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">Pericolic</span> inflammation</li>\n<li>Ib: <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">Pericolic</span> abscess <strong>(Statement 4 ruled out)</strong></li>\n</ul>\n</li>\n<li>Stage II: <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> abscess</li>\n<li>Stage III: <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">Purulent</span> peritonitis</li>\n<li>Stage IV: Fecal peritonitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemorrhage (painless and profuse)</li>\n<li>Perforation (can cause <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">pericolic</span> abscess)</li>\n<li>Intestinal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (large or small bowel)</li>\n<li>Fistula Formation (e.g., colovesical) <strong>(Statement 5 ruled out)</strong></li>\n<li>Leads to frequent UTIs, fecaluria, pneumaturia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/akWeyAa0jyFHfg5LRJZo1748862158.mp3", "video": ""}, {"text": "Which variant of Familial Adenomatous Polyposis is associated with both colorectal cancer and brain tumors?", "options": [{"label": "A", "text": "Classic FAP", "correct": false}, {"label": "B", "text": "Attenuated FAP", "correct": false}, {"label": "C", "text": "Gardner's Syndrome", "correct": false}, {"label": "D", "text": "Turcot Syndrome", "correct": true}], "correct_answer": "D. Turcot Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Zvvt9x3eoCxhroQBtNNi1740023347.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:431px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classic <span class=\"customMeta\" data-dictid=\"3140428620169277720288fbf74aad\">FAP</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> with extensive polyps</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Attenuated <span class=\"customMeta\" data-dictid=\"3140428620169277720288fbf74aad\">FAP</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Milder <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> with fewer polyps</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gardner syndrome <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classic <span class=\"customMeta\" data-dictid=\"3140428620169277720288fbf74aad\">FAP</span> + additional tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turcot syndrome <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FAP <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> with brain tumor</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:605px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gardner Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Turcot Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autosomal dominant variant</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> variant</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with</p>\n<ul>\n<li>Osteoma</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">Hypertrophy</span> of <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">Pigment</span> Epithelium(CHRPE)</li>\n<li>Desmoid tumor</li>\n<li>Epidermoid cyst</li>\n<li>Supernumerary teeth</li>\n<li>Benign <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">polyposis</span> of ileum</li>\n<li>Sebaceous cyst</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with brain tumors in both <span class=\"customMeta\" data-dictid=\"3140428620169277720288fbf74aad\">FAP</span> and lynch syndrome</p>\n<ul>\n<li>In FAP, causes Medulloblastoma.</li>\n<li>In lynch syndrome, causes <span class=\"customMeta\" data-dictid=\"c9b2c1943e1692777188917d65bd7e\">Glioblastoma</span> multiforme.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KQWZmj48C6LssVjUZyMG1748862771.mp3", "video": ""}, {"text": "A 45-year-old woman presents with a history of recurrent colorectal cancer. Her family history reveals that her mother was diagnosed with endometrial cancer at age 50, and her aunt had ovarian cancer. Genetic testing is recommended. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cowden Syndrome", "correct": false}, {"label": "B", "text": "Lynch Syndrome", "correct": true}, {"label": "C", "text": "Peutz-Jeghers Syndrome", "correct": false}, {"label": "D", "text": "MUTYH-Associated Polyposis (MAP)", "correct": false}], "correct_answer": "B. Lynch Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:429px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amsterdam II Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Three or more family members with <span class=\"customMeta\" data-dictid=\"e968ed6cf4169277719124aa9b6e77\">Lynch syndrome</span> related cancer, one of whom is a 1° relative.</li>\n<li>Two or more successive affected generations.</li>\n<li>At least one tumor diagnosed before 50 years.</li>\n<li>FAP excluded</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RGJgYBwS3M4oAbDhkN4v1748862918.mp3", "video": ""}, {"text": "A 35-year-old woman presents with multiple oral papillomas, facial trichilemmomas, and a history of thyroid nodules. She also reports that her mother had breast cancer at a young age. On examination, multiple small, wart-like growths on her hands is noted. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Neurofibromatosis", "correct": false}, {"label": "B", "text": "Cowden disease", "correct": true}, {"label": "C", "text": "Peutz-Jeghers syndrome", "correct": false}, {"label": "D", "text": "Gardner syndrome", "correct": false}], "correct_answer": "B. Cowden disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ARHB0LBAqri75lD02IKP1740023417.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bclhIMbHFRFGIFalwqu41748863083.mp3", "video": ""}, {"text": "A 45-year-old male presents with severe abdominal pain, vomiting, and abdominal distension along with tenderness. X-ray shows dilated bowel loops with air-fluid levels. The patient is taken for exploratory laparotomy. Which of the following structures is most likely to be visualized first to differentiate between small intestine and large intestine obstruction?", "options": [{"label": "A", "text": "Cecum", "correct": true}, {"label": "B", "text": "Ileum", "correct": false}, {"label": "C", "text": "Ascending Colon", "correct": false}, {"label": "D", "text": "Sigmoid Colon", "correct": false}], "correct_answer": "A. Cecum", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0aI5iRvkeZQObizMx1eo1748859480.mp3", "video": ""}, {"text": "A 60-year-old male presents with severe abdominal pain, distension, and constipation. A CT scan reveals a large intestinal obstruction at the level of the descending colon. Which of the following arteries is primarily responsible for providing collateral circulation in this situation?", "options": [{"label": "A", "text": "Superior Mesenteric Artery", "correct": false}, {"label": "B", "text": "Inferior Mesenteric Artery", "correct": false}, {"label": "C", "text": "Marginal Artery of Drummond", "correct": true}, {"label": "D", "text": "Arc of Riolan", "correct": false}], "correct_answer": "C. Marginal Artery of Drummond", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pIQykvEvha3zdAkdNzcd1740022270.png", "https://image.prepladder.com/content/vUSY3biKZ2xGb2VmQCxa1740022348.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cecum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connects to the <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> via the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> valve, located in the lower right abdomen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ascending Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs upward on the right side of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to the <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> flexure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transverse Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends horizontally across the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> from the <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"13e47cfa68169277720299cd54beb4\">flexure</span> to the splenic flexure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Descending Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Travels downward on the left side from the splenic <span class=\"customMeta\" data-dictid=\"13e47cfa68169277720299cd54beb4\">flexure</span> to the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S-shaped section connecting the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> to the rectum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stores fecal matter before expulsion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminal part of the <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> tract, through which <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> are expelled.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood and Nerve supply of the Large Intestine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Superior Mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (SMA):</strong> Supplies the cecum, <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon, and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> two-thirds of the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon. <strong>(Option A)</strong></li>\n<li><strong>Inferior Mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (IMA):</strong> Supplies the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> one-third of the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon, <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> colon, <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon, and rectum. <strong>(Option B)</strong></li>\n<li><strong>Marginal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> of Drummond:</strong> An important arterial <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> running along the inner border of the colon, connecting branches of the SMA and IMA, ensuring continuous blood supply and providing <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> circulation. <strong>(Option C)</strong></li>\n<li><strong>Arc of Riolan / Meandering mesenteric artery: </strong>It is a <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> branch running close to the mesentery, connecting superior mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> mesenteric artery. It also connects <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> part of middle colic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> to left colic artery<strong>(Option D)</strong></li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/vUSY3biKZ2xGb2VmQCxa1740022348.png\" width=\"500\"/><br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood from the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> drains into the <strong>superior mesenteric <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> </strong>and <strong>inferior mesenteric vein</strong>, which then drain into the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> leading to the liver.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymph from the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> drains into the <strong>mesenteric <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</strong> and ultimately into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> duct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parasympathetic Supply:</strong></p>\n<ul>\n<li>Vagus nerve: Up to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> two-thirds of the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon.</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"dbdb1e19591692777199e0d8fb2522\">splanchnic</span> nerves: From the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> one-third of the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> onward.</li>\n</ul>\n<p><strong>Sympathetic Supply:</strong></p>\n<p>Superior and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> mesenteric plexuses.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BVMAUC0nk3IVciQy3rqK1748861405.mp3", "video": ""}, {"text": "Assertion: The colon plays a significant role in the production of short-chain fatty acids (SCFAs) from dietary fibers. Reason: Fermentation of dietary fibers by gut bacteria in the colon produces SCFAs like butyrate, acetate, and propionate, which serve as metabolic fuel for colon cells.", "options": [{"label": "A", "text": "Both Assertion and Reason are true, and the Reason is the correct explanation for the Assertion.", "correct": true}, {"label": "B", "text": "Both Assertion and Reason are true, but the Reason is not the correct explanation for the Assertion.", "correct": false}, {"label": "C", "text": "The Assertion is true, but the Reason is false.", "correct": false}, {"label": "D", "text": "Both Assertion and Reason are false", "correct": false}], "correct_answer": "A. Both Assertion and Reason are true, and the Reason is the correct explanation for the Assertion.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Water and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> Absorption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absorbs water, sodium (Na+), and <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (Cl-) to maintain fluid and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> balance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secretes <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> (K+), <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> (HCO3-), and <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> to protect <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and facilitate fecal passage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fermentation and <span class=\"customMeta\" data-dictid=\"de5971d6291692777198a72d88879c\">SCFA</span> Production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ferments dietary fibers to produce short-chain <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids (SCFAs) like butyrate, acetate, and propionate, which serve as <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> fuel for <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cells.</li>\n<li>The right colon, particularly the cecum, is the primary <span class=\"customMeta\" data-dictid=\"cc108d77f11692777202478d5c72bf\">fermentation</span> site. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Storage and <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">Dehydration</span> of Stool</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The left <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> stores fecal matter and absorbs water to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> solid stools.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin Production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gut bacteria <span class=\"customMeta\" data-dictid=\"37ab4f3d3a16927771991ff7316442\">synthesize</span> vitamins such as <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">vitamin K</span> and some B vitamins, which are absorbed by the colon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protection and Immunity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides a barrier against pathogens through mucus, epithelial tight junctions, and immune cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motility and Transit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exhibits peristaltic movements to mix contents and move them toward the rectum.</li>\n<li>Mass <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> propels fecal matter for defecation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regulation of pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absorbs SCFAs and secretes <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> to maintain <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> pH for bacterial activity and <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> function.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mGWEGPpU9V5vd9mL53CB1748861506.mp3", "video": ""}, {"text": "A 2-day-old neonate presents with abdominal distension, vomiting, and failure to pass meconium within the first 48 hours of life. On physical examination, the abdomen is distended, and a digital rectal examination reveals a tight anal sphincter with an explosive discharge of stool upon withdrawal of the finger. What is the best step of investigation to confirm the exact pathology?", "options": [{"label": "A", "text": "Abdominal X-ray", "correct": false}, {"label": "B", "text": "Barium enema", "correct": false}, {"label": "C", "text": "Rectal biopsy", "correct": true}, {"label": "D", "text": "Anorectal manometry", "correct": false}], "correct_answer": "C. Rectal biopsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sFDLj81LDIu9HtZ5sDzK1740022422.png", "https://image.prepladder.com/content/0ELrj9VkUuJ0jKnetJbZ1740022471.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Introduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital disorder known as <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"d12ec4bbdf1692777180ebae2680b2\">aganglionic</span> <span class=\"customMeta\" data-dictid=\"944688061e16927771929fa8717176\">megacolon</span> or aganglionosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in myenteric (Auerbach) and <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> (Meissner) plexuses.</li>\n<li>Continuous <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of the affected <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> segment, leading to functional obstruction.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> due to chronic obstruction.</li>\n<li>Typically affects the <span class=\"customMeta\" data-dictid=\"d54167c73316927771970038452d57\">rectosigmoid</span> region but can involve the entire <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> in severe cases.</li>\n</ul>\n<br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/sFDLj81LDIu9HtZ5sDzK1740022422.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CLINICAL PRESENTATION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neonates:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Failure to pass <span class=\"customMeta\" data-dictid=\"19a40edc9816927771924fd7dd0efa\">meconium</span> within the first 48 hours.</li>\n<li>Abdominal distension.</li>\n<li>Bilious vomiting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants and Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic constipation</li>\n<li>Poor feeding</li>\n<li>Failure to thrive</li>\n<li>Enterocolitis (fever, diarrhea, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DIAGNOSIS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History and <span class=\"customMeta\" data-dictid=\"27ac5e3413169277719548c1b36288\">physical examination</span> indicating chronic <span class=\"customMeta\" data-dictid=\"281b8ef3701692777185aa34365916\">constipation</span> and failure to pass meconium.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal X-ray: </strong>Shows dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops with air-fluid levels. <strong>(Option A)</strong></p>\n<p><img alt=\"\" data-author=\"Hidayatullah Hamidi\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/hirschsprung-disease-short-segment-1#image-39326094\" data-tags=\"\" height=\"608\" src=\"https://image.prepladder.com/content/0ELrj9VkUuJ0jKnetJbZ1740022471.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast (Barium) Enema:</strong> Demonstrates a transition zone between dilated <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> and narrow <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> bowel. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectal Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gold standard</strong> and IOC for diagnosis, showing the absence of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anorectal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows lack of rectoanal <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> reflex. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MANAGEMENT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stabilization with <span class=\"customMeta\" data-dictid=\"bc3c2594d31692777203b12c564dae\">fluid resuscitation</span> and <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> of the colon.</li>\n<li>Antibiotics for <span class=\"customMeta\" data-dictid=\"85d2909f961692777187ea2494afd9\">enterocolitis</span> if present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definitive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pull-Through Procedures:</strong> Removal of the <span class=\"customMeta\" data-dictid=\"d12ec4bbdf1692777180ebae2680b2\">aganglionic</span> segment and pulling through the normal <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> to the anus.</li>\n<li><strong>Swenson Procedure:</strong> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> of the <span class=\"customMeta\" data-dictid=\"d12ec4bbdf1692777180ebae2680b2\">aganglionic</span> segment with <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> to the anus.</li>\n<li><strong>Duhamel Procedure: </strong>Ganglionic <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> brought down behind the <span class=\"customMeta\" data-dictid=\"d12ec4bbdf1692777180ebae2680b2\">aganglionic</span> segment, side-to-side anastomosis.</li>\n<li><strong>Soave Procedure:</strong> Removing the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of the <span class=\"customMeta\" data-dictid=\"d12ec4bbdf1692777180ebae2680b2\">aganglionic</span> segment, pulling the <span class=\"customMeta\" data-dictid=\"64b80455111692777188900f7c20cf\">ganglionic</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> through the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> cuff.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HJgmboHE0DVXU49mKIxy1748861624.mp3", "video": ""}, {"text": "A 55-year-old male presents to the clinic with complaints of intermittent chest pain and difficulty swallowing. He gives a history of gastrointestinal discomfort and was recently diagnosed with both hiatal hernia and diverticulosis during a routine endoscopic examination. Given his current history, what is the other condition that has the highest probability for which he should be evaluated?", "options": [{"label": "A", "text": "Gallstones", "correct": true}, {"label": "B", "text": "Peptic ulcer disease", "correct": false}, {"label": "C", "text": "Inflammatory bowel disease", "correct": false}, {"label": "D", "text": "Chronic pancreatitis", "correct": false}], "correct_answer": "A. Gallstones", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jaNqeghPJ3ZTuFBEpp3w1748861755.mp3", "video": ""}, {"text": "A 55-year-old patient presents with symptoms of abdominal pain and changes in bowel habits. A barium enema is performed, which reveals a characteristic finding on imaging given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Diverticulosis", "correct": true}, {"label": "B", "text": "Colon Cancer", "correct": false}, {"label": "C", "text": "Pseudomembranous Colitis", "correct": false}, {"label": "D", "text": "Ischemic colitis", "correct": false}], "correct_answer": "A. Diverticulosis", "question_images": ["https://image.prepladder.com/notes/FPkiXxe9HkD0JR3ALE3Y1748862302.png"], "explanation_images": ["https://image.prepladder.com/content/BaGUbYGo1bgmAXE6jM1S1740022748.png", "https://image.prepladder.com/content/0uDVwZbeplj8IzwmrT3v1740022825.png", "https://image.prepladder.com/content/IryNbyfKL3j84Nwt6ORy1740022873.png", "https://image.prepladder.com/content/KeCn5qMlcHm92izMc6T91740022913.png", "https://image.prepladder.com/content/mSyPvSEdaBpM6VTxIPz01740022970.png", "https://image.prepladder.com/content/sWgMjAKompOTQ95PT5v81740023032.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of small, bulging pouches (diverticula) in the colon, most commonly in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/BaGUbYGo1bgmAXE6jM1S1740022748.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diet: Low-fiber diet increases <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> pressure.</li>\n<li>Age: More common in those over 60.</li>\n<li>Genetics: Family history may increase risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased pressure: High <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> pressure causes weak spots to bulge.</li>\n<li>Weak <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> wall: Weak areas, especially where blood vessels enter the mucosa, are <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to forming diverticula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>False diverticula: Involve only the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and submucosa.</li>\n<li>Multiple and acquired: Typically multiple and not congenital.</li>\n<li>Location: Most commonly in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon, along the mesenteric aspect.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often asymptomatic; may include mild <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort, bloating, and changes in <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Colonoscopy:</strong> Direct visualization.</li>\n<li><strong>CT Scan:</strong> Detailed images of the colon.</li>\n<li><strong>Barium enema:</strong> Less common, show a characteristic sawtooth appearance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diet: Increase fiber intake.</li>\n<li>Hydration: Drink plenty of fluids.</li>\n<li>Exercise: Promotes healthy <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lower GI Bleed: Common cause of lower <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LMqUYXbONo7JIEY4pJLL1748861950.mp3", "video": ""}, {"text": "Which of the following correctly identifies a type of non-neoplastic polyp?", "options": [{"label": "A", "text": "Tubular adenomatous polyp", "correct": false}, {"label": "B", "text": "Sessile serrated polyp", "correct": false}, {"label": "C", "text": "Juvenile polyp", "correct": true}, {"label": "D", "text": "Villous adenomatous polyp", "correct": false}], "correct_answer": "C. Juvenile polyp", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neoplastic Polyps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Neoplastic Polyps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenomatous Polyps </strong>(Adenomas)</p>\n<ul>\n<li>Tubular <strong>(Option A)</strong></li>\n<li>Villous <strong>(Option D)</strong></li>\n<li>Tubulovillous</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory Polyps</strong></p>\n<p>Associated with <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease (e.g., Crohn's disease, <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serrated Polyps</strong></p>\n<ul>\n<li>Hyperplastic Polyps</li>\n<li>Sessile Serrated Adenomas (SSA/Ps) <strong>(Option B)</strong></li>\n<li>Traditional Serrated Adenomas (TSAs)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hamartomatous Polyps</strong></p>\n<ul>\n<li><strong>Juvenile Polyps: </strong>Usually in children, generally <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> but associated with <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">Polyposis</span> Syndrome. <strong>(Option C)</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Peutz-Jeghers Polyps: </strong>Associated with Peutz-Jeghers syndrome, characterized by <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> around the mouth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphoid Polyps</strong></p>\n<p>Composed of <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue, usually <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> and associated with the immune response</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gw7PEspiNH6JEyMaZJvP1748862310.mp3", "video": ""}, {"text": "A 16-year-old girl presents with intermittent abdominal pain, occasional rectal bleeding, and pigmented macules on her lips, buccal mucosa, and digits. Her mother had similar pigmented spots. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Familial Adenomatous Polyposis (FAP)", "correct": false}, {"label": "B", "text": "Lynch Syndrome", "correct": false}, {"label": "C", "text": "Peutz-Jeghers Syndrome", "correct": true}, {"label": "D", "text": "Cowden Syndrome", "correct": false}], "correct_answer": "C. Peutz-Jeghers Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gErOIFjVgYeKfBODR3X51740023155.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cqGwWPwQ1PLQA84nNfx61748862507.mp3", "video": ""}, {"text": "A 16-year-old boy is brought to the clinic by his mother due to rectal bleeding. His father died of colon cancer at age 40. Colonoscopy reveals hundreds of polyps throughout the colon. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Crohn's disease", "correct": false}, {"label": "B", "text": "Familial adenomatous polyposis (FAP)", "correct": true}, {"label": "C", "text": "Lynch syndrome", "correct": false}, {"label": "D", "text": "Juvenile polyposis syndrome", "correct": false}], "correct_answer": "B. Familial adenomatous polyposis (FAP)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JDeAuiwLG10UbDJ5vyW61740023263.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DsR80cRcxri7ds8OkM881748862626.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 62-year-old patient is diagnosed with a large, invasive adenocarcinoma of the splenic flexure of the colon. The colorectal surgeon recommends surgical resection. Which of the following colectomy procedures would be most appropriate for this patient?", "options": [{"label": "A", "text": "Left hemicolectomy", "correct": false}, {"label": "B", "text": "Extended left hemicolectomy", "correct": true}, {"label": "C", "text": "Subtotal colectomy", "correct": false}, {"label": "D", "text": "Total proctocolectomy", "correct": false}], "correct_answer": "B. Extended left hemicolectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Uaq48jEPfUIquUS5MmFX1740023724.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">Colectomy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures removed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total Colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of entire colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total Proctocolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">Colectomy</span> + removal of rectum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subtotal Colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of entire <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> except the rectum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right Hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminal ileum, cecum, <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> flexure, right half of <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extended Right Hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminal ileum, cecum, <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> flexure, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> 2/3rd of <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left Hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal 1/3rd of <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon, splenic flexure, <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> colon, portion of <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extended Left Hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal 2/3rd of <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon, splenic flexure, <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> colon, portion of <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transverse Colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sigmoid Colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TsewLqKIQtjINQ3DPMHg1748870428.mp3", "video": ""}, {"text": "A 15-year-old patient is diagnosed with juvenile polyposis syndrome (JPS). Which of the following statements accurately describes the management and characteristics of JPS?", "options": [{"label": "A", "text": "The initial colonoscopy screening should be started by age 10", "correct": false}, {"label": "B", "text": "JPS is caused by mutations in the SMAD4 or BMPR1A genes", "correct": true}, {"label": "C", "text": "Prophylactic colectomy is indicated only when iron-deficiency anemia is present", "correct": false}, {"label": "D", "text": "Best managed with immediate total colectomy regardless of the number of polyps", "correct": false}], "correct_answer": "B. JPS is caused by mutations in the SMAD4 or BMPR1A genes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Juvenile polyp</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant inheritance; Mutations in <strong>BMPR1A, SMAD4, or <span class=\"customMeta\" data-dictid=\"a3d205a9e21692777187ef4367df5f\">ENG</span> genes</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Key Characteristics</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hamartomatous polyps</strong><strong> </strong>in intestines</li>\n<li>No <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> (unlike Peutz–Jeghers syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cancer Risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10% to 38% lifetime risk of <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer; Average age of diagnosis: 34 years</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Diagnosis</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>At least five</strong> <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">juvenile</span> polyps in the <strong>colorectum</strong></li>\n<li><strong>Multiple</strong> <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">juvenile</span> polyps <strong>throughout </strong>the GI tract</li>\n<li>Any number of <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">juvenile</span> polyps with a <strong>family history of JPS</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute or chronic <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding</li>\n<li>Iron-deficiency anemia</li>\n<li>Prolapsed rectal polyps</li>\n<li>Abdominal pain</li>\n<li>Diarrhea</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Screening Recommendations</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial <span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\">colonoscopy</span> between ages 12 and 15 <strong>(Option A)</strong></li>\n<li>Repeat <span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\">colonoscopy</span> in 2-3 years if no polyps are found</li>\n<li>Annual colonoscopies if polyps are found and removed</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical Indications <strong>(Option D)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>High-grade <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> or cancer</strong><strong> </strong>presence</li>\n<li><strong>Polyp burden unmanageable</strong><strong> </strong>endoscopically</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical Options</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subtotal <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">colectomy</span> with <span class=\"customMeta\" data-dictid=\"4a6d566b9f1692777189121dd4c99d\">ileorectal</span> <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> <strong>(IRA)</strong></li>\n<li><strong>Segmental colectomy</strong></li>\n<li>Total <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">colectomy</span> with ileal pouch-anal <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> <strong>(IPAA)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prophylactic Surgery Considerations<strong> </strong><strong>(Option C)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Poor surveillance compliance</strong></li>\n<li><strong>Family history </strong>of <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qEKZUgyFV5qtSiNqmykh1748871704.mp3", "video": ""}, {"text": "A 65-year-old male presents with acute lower gastrointestinal bleeding. He is hemodynamically stable but has a significant amount of blood in his stool. What is the next best step in management?", "options": [{"label": "A", "text": "Outpatient colonoscopy", "correct": false}, {"label": "B", "text": "Immediate surgery", "correct": false}, {"label": "C", "text": "CT angiogram", "correct": false}, {"label": "D", "text": "Inpatient colonoscopy", "correct": true}], "correct_answer": "D. Inpatient colonoscopy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lower GI Bleeding</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding from the GI <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of Treitz (jejunum to anus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diverticular Disease: Pouches in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> wall.</li>\n<li>Angiodysplasia: <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> with dilated, <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> veins in the colon.</li>\n<li>Heyde’s disease: Characterized by both <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> and angiodysplasia.</li>\n<li>IBD: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> and ulceration.</li>\n<li>Colonic Polyps: Growths in the colon.</li>\n<li>Colorectal Cancer: Bleeding, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habit changes, anaemia.</li>\n<li>Infectious Colitis: Bloody diarrhoea, possible perforation.</li>\n<li>Ischemic Colitis: <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> blood flow, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in splenic flexure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">Bleeding</span> with Hypovolemic Shock: CT angiogram, embolisation, <span class=\"customMeta\" data-dictid=\"3bf044268816927771904277498f20\">inpatient</span> colonoscopy, <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> endoscopy/surgery.</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">Bleeding</span> without Hypovolemic Shock: <span class=\"customMeta\" data-dictid=\"3bf044268816927771904277498f20\">Inpatient</span> colonoscopy, EGD, <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> endoscopy/CT angiogram/nuclear medicine scanning.</li>\n<li>Minor Bleeding: <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">Outpatient</span> investigations.</li>\n<li>General Considerations: Withhold anticoagulants, transfuse blood products as needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Specifics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angiodysplasia: CT angiography, embolisation, colonoscopy, <span class=\"customMeta\" data-dictid=\"06a6e8bfbb169277718202d47f2d42\">argon</span> laser, surgery if severe.</li>\n<li>Diverticular Disease: High-fiber diet, laxatives, antibiotics, surgery for complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Importance of Accurate Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiating between diverticular <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and <span class=\"customMeta\" data-dictid=\"22062c928f169277718177a5c7bd93\">angiodysplasia</span> is crucial for appropriate treatment. Early diagnosis improves outcomes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SCFaMWSHY4h0GX2wRVfG1748871488.mp3", "video": ""}, {"text": "A 65-year-old woman presents to the emergency department with a sudden onset of severe abdominal pain, bloody diarrhea, and low-grade fever. Her medical history includes hypertension and a recent episode of congestive heart failure. An abdominal CT scan reveals signs of bowel ischemia. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute mesenteric ischemia", "correct": false}, {"label": "B", "text": "Ischemic colitis", "correct": true}, {"label": "C", "text": "Diverticulitis", "correct": false}, {"label": "D", "text": "Crohn's disease", "correct": false}], "correct_answer": "B. Ischemic colitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:715px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ischemic Colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ischemic <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> is the most common <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> ischemia. It occurs when there is insufficient <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the colon, leading to tissue injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombotic occlusion: Often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to atherosclerosis; presents with <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, raised white cell count, and rectal bleeding.</li>\n<li>Embolic events: Can cause <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> with severe pain, bloody diarrhea, and <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability.</li>\n<li>Low-flow states: Conditions like <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock, heart failure, and <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> increase the risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Predominantly affects older adults, women, and individuals with comorbidities.</li>\n<li>Increased risk in case of atherosclerosis, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries, certain medications, and illicit drug use.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Sudden <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, tenesmus, bloody diarrhea, nausea, vomiting, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> fever, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension, and tenderness.</li>\n<li>Mild cases may have <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> symptoms; severe cases can lead to shock and require urgent treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Imaging:\n\t\t\t\t<ul>\n<li>Abdominal plain films may show \"thumb-printing\";</li>\n<li>CT scans with contrast are preferred.</li>\n</ul>\n</li>\n<li>Colonoscopy: Gold standard for diagnosis, showing characteristic mucosal changes.</li>\n<li>Vascular Imaging: Used in suspected <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> mesenteric ischemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative Management: Includes <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> rest, IV fluids, <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics, and addressing underlying conditions.</li>\n<li>Surgical Intervention: Necessary for severe cases; involves removing gangrenous <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> and ensuring adequate blood supply.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mESZlNlxI0BPElvqBSoH1748871369.mp3", "video": ""}, {"text": "A 65-year-old male presents with a 5-day history of watery diarrhea, abdominal cramping, and low-grade fever. He was recently treated with cephalosporins for a respiratory infection. Upon examination, the patient is dehydrated but stable. Endoscopy reveals raised yellowish-white plaques on the colonic mucosa. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Crohn’s disease", "correct": false}, {"label": "C", "text": "Pseudomembranous colitis", "correct": true}, {"label": "D", "text": "Ischemic colitis", "correct": false}], "correct_answer": "C. Pseudomembranous colitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudomembranous Colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily caused by <span class=\"customMeta\" data-dictid=\"27791cc8181692777184b363360a3c\">Clostridium</span> difficile infection.</li>\n<li>Often associated with <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> use, especially cephalosporins.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, fever.</li>\n<li>Severe cases: Pseudomembranous <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> with raised, yellowish-white plaques on <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> mucosa.</li>\n<li>Nonspecific <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> or <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> may also occur, with a higher risk of perforation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Based on clinical symptoms and <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> tests for C. difficile toxins, antigens, or bacteria.</li>\n<li>Flexible <span class=\"customMeta\" data-dictid=\"bcae8561fa16927771989814c536d0\">sigmoidoscopy</span> for inconclusive <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> tests or excluding other causes.</li>\n<li>Colonoscopy used cautiously in <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> colitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics: Oral vancomycin, fidaxomicin, or metronidazole.</li>\n<li>Fecal <span class=\"customMeta\" data-dictid=\"ee4913785d16927771929d78b794c7\">microbiota</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for unresponsive cases.</li>\n<li>Emergency <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">subtotal</span> <span class=\"customMeta\" data-dictid=\"b2ba93970916927771843a4ee3c4fd\">colectomy</span> and <span class=\"customMeta\" data-dictid=\"fd21e4e7c116927771898e2055e14b\">ileostomy</span> for severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Isolation of suspected cases.</li>\n<li>Use of protective equipment by healthcare staff.</li>\n<li>Thorough <span class=\"customMeta\" data-dictid=\"6c1d540906169277718659e8eb7f9c\">disinfection</span> and meticulous hand hygiene.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dWHwFjp7ZyssEJyruDQk1748871262.mp3", "video": ""}, {"text": "A 45-year-old woman, recently diagnosed with colon and bladder cancer, presents with a notable family history; her mother also had both cancers and succumbed to them. Additionally, she has a history of sebaceous adenomas. Which other malignancy should she be evaluated for, considering the potential hereditary cancer syndrome?", "options": [{"label": "A", "text": "Thyroid cancer", "correct": false}, {"label": "B", "text": "Liver cancer", "correct": false}, {"label": "C", "text": "Breast carcinoma", "correct": true}, {"label": "D", "text": "Pancreatic cancer", "correct": false}], "correct_answer": "C. Breast carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:745px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A genetic disorder characterised by <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> tumours and internal malignancies.</li>\n<li>Variant of <span class=\"customMeta\" data-dictid=\"e968ed6cf4169277719124aa9b6e77\">Lynch syndrome</span> (hereditary nonpolyposis <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Basis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mutations in <span class=\"customMeta\" data-dictid=\"d949802d90169277719238da3d8f63\">mismatch repair</span> genes: MLH1, MSH2, MSH6, PMS2, EPCAM.</li>\n<li>Inheritance: Autosomal dominant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Cancers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sebaceous Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes adenomas, carcinomas, and hyperplasia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colorectal Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common. Diagnosed by <span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\">colonoscopy</span> and genetic testing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genitourinary Cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes bladder, ureters, and kidneys. Diagnosed with <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> and cystoscopy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Managed with <span class=\"customMeta\" data-dictid=\"a1672bc5881692777191cad63bc4a8\">mammography</span> and possibly breast MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes non-Hodgkin lymphoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Modalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Genetic Testing: To identify <span class=\"customMeta\" data-dictid=\"bcfa9a33261692777192ffd3683447\">MMR</span> gene mutations.</li>\n<li>Microsatellite <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">Instability</span> Testing</li>\n<li>Immunohistochemistry: <span class=\"customMeta\" data-dictid=\"bcfa9a33261692777192ffd3683447\">MMR</span> protein expression.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management and Counseling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surveillance</li>\n<li>Preventive measures like <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> surgery and lifestyle modifications.</li>\n<li>Genetic counseling and family testing</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mitjuwpU4ec84IJxi8UH1748871143.mp3", "video": ""}, {"text": "Which of the following statements regarding the therapy for colon carcinoma are correct? Statements: Chemotherapy is often used in the adjuvant setting after surgery to reduce the risk of recurrence in patients with Stage III colon cancer. Immunotherapy is typically used as a first-line treatment for patients with colon cancer who have microsatellite instability-high (MSI-H) or mismatch repair deficiency. Chemotherapy with FOLFOX (5-Fluorouracil, Leucovorin, and Oxaliplatin) is commonly used for Stage IV colon cancer to achieve a cure. Checkpoint inhibitors like Pembrolizumab are effective in colon cancer patients with microsatellite instability-high (MSI-H) or mismatch repair deficiency. Radiotherapy is not preferred for colon cancer due to its limited benefit in local control.", "options": [{"label": "A", "text": "1, 2, and 4", "correct": false}, {"label": "B", "text": "2, 4, and 5", "correct": false}, {"label": "C", "text": "1, 4, and 5", "correct": true}, {"label": "D", "text": "3, 4, and 5", "correct": false}], "correct_answer": "C. 1, 4, and 5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:320px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Components</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FOLFOX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>5-Fluorouracil (5-FU)</li>\n<li>Folinic Acid</li>\n<li>Oxaliplatin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FOLFIRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>5-Fluorouracil (5-FU)</li>\n<li>Folinic Acid</li>\n<li>Irinotecan</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CapeOx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Capecitabine</li>\n<li>Oxaliplatin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pembrolizumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(Checkpoint inhibitor) PD-1 inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nivolumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PD-1 <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> (sometimes combined with Ipilimumab)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ipilimumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CTLA-4 <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> (sometimes combined with Nivolumab)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bevacizumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-VEGF antibody, inhibits <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cetuximab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-EGFR antibody, effective in KRAS <span class=\"customMeta\" data-dictid=\"1aef6f42b91692777202311ae20455\">wild-type</span> tumours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Panitumumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Cetuximab, fully humanized to reduce allergic reactions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6kCZgxfRZokvNxRUw5Tb1748870908.mp3", "video": ""}, {"text": "A 62-year-old male underwent a right hemicolectomy for carcinoma of the colon. On the fourth postoperative day, he developed severe abdominal pain, fever, tachycardia, and hypotension. On physical examination, his abdomen is distended and diffusely tender with guarding and rigidity. Laboratory results show elevated white blood cell count. A CT scan of the abdomen reveals free fluid and air in the peritoneal cavity. Considering the clinical presentation and imaging findings, what is the most likely cause of his current condition?", "options": [{"label": "A", "text": "Surgical site infection", "correct": false}, {"label": "B", "text": "Anastomotic leak", "correct": true}, {"label": "C", "text": "Bowel obstruction", "correct": false}, {"label": "D", "text": "Ileus", "correct": false}], "correct_answer": "B. Anastomotic leak", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve Injured</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (IMA) Ligation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Near sacral promontory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"b3df9929201692777189f8ca429cf1\">Hypogastric</span> Plexus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Retrograde <span class=\"customMeta\" data-dictid=\"9ee9011df41692777187bfb1eea894\">ejaculation</span> in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> due to <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Division of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Stalks Close to <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> Sidewall</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral stalks near <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> sidewall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">Plexus</span> &amp; <span class=\"customMeta\" data-dictid=\"a31d23e9c616927771934b1ad90b45\">Nervi</span> Erigentes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erectile dysfunction, impotence, and atonic bladder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Periprostatic region</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Periprostatic Plexus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sexual <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., incontinence)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Resection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic <span class=\"customMeta\" data-dictid=\"dbdb1e19591692777199e0d8fb2522\">splanchnic</span> nerves</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic <span class=\"customMeta\" data-dictid=\"dbdb1e19591692777199e0d8fb2522\">Splanchnic</span> Nerves</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> and <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Mesorectal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> (TME)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within the mesorectum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autonomic nerves within the mesorectum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> in men, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> incontinence</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DPXVBjApplafIhXahnVZ1748870710.mp3", "video": ""}, {"text": "A 55-year-old male presents with fatigue, weight loss, and intermittent abdominal pain. He has a history of occasional rectal bleeding. On examination, he has mild pallor, and there is a palpable mass in the right upper quadrant. A colonoscopy is performed, revealing a large ulcerative mass at the hepatic flexure of the colon. Biopsy confirms the diagnosis of adenocarcinoma. What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Segmental resection of the hepatic flexure", "correct": false}, {"label": "B", "text": "Right hemicolectomy", "correct": false}, {"label": "C", "text": "Extended right hemicolectomy", "correct": true}, {"label": "D", "text": "Total colectomy", "correct": false}], "correct_answer": "C. Extended right hemicolectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2jwpCrsh4SWBFxaNI90e1744006197.png", "https://image.prepladder.com/notes/Gb1RMVhuy6xaCcZsvs9n1744006025.png", "https://image.prepladder.com/notes/7YutYScbHOQgc2WwwSAp1744006074.png", "https://image.prepladder.com/notes/Ot9X3CWPDlpnzoxErc0F1744006292.png", "https://image.prepladder.com/notes/AEHZh9AVD9p7gfVz9JnY1743851556.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site of <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery Performed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagram of Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cecum &amp; <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU745 Cecum and &lt;span class=\" custommeta\"=\"\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\"/>ascending colon.png\" data-author=\"NA\" data-hash=\"7836\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/4ph9HfSExQME2c1Q54jy1744005827.png\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic flexure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extended right hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU746 &lt;span class=\" custommeta\"=\"\" data-dictid=\"3268e86ce01692777188f249c64d6e\"/>Hepatic flexure\" data-author=\"NA\" data-hash=\"7837\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/RcDnnqCtHqgOupVIrsZj1744005866.png\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transverse colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transverse colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU747 &lt;span class=\" custommeta\"=\"\" data-dictid=\"a6260fa86416927772008d36bd7e5f\"/>Transverse colon\" data-author=\"NA\" data-hash=\"7838\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HqpZnJL3C8XYFtBdrn431744005912.png\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Splenic flexure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extended left hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU748 Splenic flexure\" data-author=\"NA\" data-hash=\"7841\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/2jwpCrsh4SWBFxaNI90e1744006197.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Descending colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left hemicolectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU749 Descending colon\" data-author=\"NA\" data-hash=\"7839\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Gb1RMVhuy6xaCcZsvs9n1744006025.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sigmoid colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU750 Sigmoid colon\" data-author=\"NA\" data-hash=\"7840\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/7YutYScbHOQgc2WwwSAp1744006074.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectosigmoid junction, upper rectum</strong></p>\n<p><strong>&amp; middle rectum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> (LAR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU751 Lower rectum\" data-author=\"NA\" data-hash=\"7842\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Ot9X3CWPDlpnzoxErc0F1744006292.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lower rectum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominoperineal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> (APR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"SU751 Lower rectum\" data-author=\"NA\" data-hash=\"7675\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/AEHZh9AVD9p7gfVz9JnY1743851556.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/x6jzcxVUY5OcbIrHOvAt1748870588.mp3", "video": ""}, {"text": "A 54-year-old female with intractable diarrhea and pigmentation was diagnosed with Cronkhite-Canada syndrome. Which of the following statements regarding the disease are true? Hamartomatous polyp of colon Seen only in females Polyps can be present in the stomach and duodenum as well 15% can turn malignant", "options": [{"label": "A", "text": "1,4", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "1,2", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": true}], "correct_answer": "D. 1,2,3,4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bwIaIyIRMmQBm8QuRvr21747830291.mp3", "video": ""}, {"text": "Which chemotherapy regimen is standard for adjuvant treatment in a patient with stage III colon cancer?", "options": [{"label": "A", "text": "Capecitabine", "correct": false}, {"label": "B", "text": "FOLFOX", "correct": true}, {"label": "C", "text": "FOLFIRI", "correct": false}, {"label": "D", "text": "Bevacizumab", "correct": false}], "correct_answer": "B. FOLFOX", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STAGE OF <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">COLON</span> CANCER</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CHEMOTHERAPY</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STAGE III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FOLFOX</strong></p>\n<ul>\n<li><strong>FOL:</strong> <span class=\"customMeta\" data-dictid=\"699ed0930f1692777203617cf3f0c7\">Folinic acid</span> (Leucovorin)</li>\n<li><strong>F:</strong> 5-Fluorouracil</li>\n<li><strong>OX</strong>: Oxaliplatin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STAGE IV/Metastatic <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line therapy: FOLFIRI</strong></p>\n<ul>\n<li><strong>FOL: </strong>Folinic acid (Leucovorin)</li>\n<li><strong>F: </strong>5-Fluorouracil</li>\n<li><strong>IRI:</strong> Irinotecan</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Second line therapy</strong>:</p>\n<ul>\n<li>Bevacizumab - <span class=\"customMeta\" data-dictid=\"acec296d051692777201ef9eae77fa\">VEGF</span> inhibitor</li>\n<li>Cetuximab - EGFR inhibitor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/L1uDXIuJOBM2uElrI0Mr1748870113.mp3", "video": ""}, {"text": "A 72-year-old female is found to have a 3 cm mass in the ascending colon during colonoscopy. A CT scan of the abdomen and pelvis shows no evidence of lymph node involvement or distant metastases. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Perform a right hemicolectomy with en-bloc lymph node dissection.", "correct": true}, {"label": "B", "text": "Recommend adjuvant chemotherapy following the surgical resection.", "correct": false}, {"label": "C", "text": "Proceed with endoscopic mucosal resection of the tumor.", "correct": false}, {"label": "D", "text": "Recommend Endoscopic polypectomy", "correct": false}], "correct_answer": "A. Perform a right hemicolectomy with en-bloc lymph node dissection.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STAGING</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TREATMENT </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 0 (Tis, N0, M0)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic polypectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 1 (T1, N0, M0)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Segmental colectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 2 (T1-3,N0,M0)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> with 5 cm margin and anastomosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 3 (T any, N1, M0)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> + <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> chemotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 4 (T any, N any, M1)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resection of <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> + <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> chemotherapy/radiotherapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/v2HLdQZ3XPUqYPEyn5wU1748865985.mp3", "video": ""}, {"text": "Which of the following is a possible description of a T3 colon tumour?", "options": [{"label": "A", "text": "Tumour invades submucosa", "correct": false}, {"label": "B", "text": "Tumour invades subserosa", "correct": true}, {"label": "C", "text": "Tumour invades adjacent organs or structures", "correct": false}, {"label": "D", "text": "Tumour confined to the mucosa", "correct": false}], "correct_answer": "B. Tumour invades subserosa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T (Tumor)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carcinoma in situ/tumour confined to <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour invades the <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour invades the <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour invades through <span class=\"customMeta\" data-dictid=\"89cf5c947f1692777199eeb0eb432c\">subserosa</span> or into pericolorectal tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours breach the visceral peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor directly invades or is adherent to other organs or structures <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N (Lymph Node)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 1 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 2-3 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1c</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor deposits in the subserosa, mesentery, or non-peritonealized <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">pericolic</span> or <span class=\"customMeta\" data-dictid=\"9626003516169277719575ac559a91\">perirectal</span> tissues without regional nodal metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N2a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 4-6 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N2b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in 7 or more regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M (Metastasis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis confined to one organ or site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to more than one organ/site or the peritoneum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1c</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis to the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> with or without other organ involvement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lkagW0hIv4uHWphixmfe1748865922.mp3", "video": ""}, {"text": "Which of the following best describes the Modified Dukes' Staging System for colorectal cancer?", "options": [{"label": "A", "text": "Dukes A: Tumour invades the muscularis propria but no lymph node involvement", "correct": false}, {"label": "B", "text": "Dukes B: Tumour penetrates through the muscularis propria with positive lymph nodes", "correct": false}, {"label": "C", "text": "Dukes C: Tumour invades beyond the bowel wall, no lymph node involvement", "correct": false}, {"label": "D", "text": "Dukes D: Tumour has distant metastasis regardless of lymph node status", "correct": true}], "correct_answer": "D. Dukes D: Tumour has distant metastasis regardless of lymph node status", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p5NXrxmHKUmE4gSXvNLQ1740023659.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STAGING</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dukes A</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor confined to the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (Stage I in modern <span class=\"customMeta\" data-dictid=\"d959e86070169277720092035c0155\">TNM</span> staging).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dukes B</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>B1- Partial <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> of <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria</li>\n<li>B2- Full <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> of <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dukes C</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>C1- LN involvement without <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> of entire <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall</li>\n<li>C2- LN involvement with <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> of entire <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dukes D</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor has distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> regardless of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> status</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mbzSA2Fmh3u3x6tuZplE1748865648.mp3", "video": ""}, {"text": "On barium enema investigation of a 54-year-old male with colon cancer an apple core lesion was found. What is the location of the carcinoma?", "options": [{"label": "A", "text": "Left", "correct": true}, {"label": "B", "text": "Right", "correct": false}, {"label": "C", "text": "Transverse colon", "correct": false}, {"label": "D", "text": "Any of the above", "correct": false}], "correct_answer": "A. Left", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right-Sided Tumours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left-Sided Tumours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cecum, <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> colon, <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> colon, <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth pattern</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically <span class=\"customMeta\" data-dictid=\"a3c898fa9e1692777196b39e3bf93c\">polypoid</span> or fungating</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> or constricting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anemia (due to chronic blood loss)</li>\n<li>Fatigue</li>\n<li>Weakness</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Altered <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits</li>\n<li>Constipation</li>\n<li>Narrow stools</li>\n<li>Obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common, vague discomfort</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common, colicky pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occult <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (melena)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hematochezia (bright red blood)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physical exam</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palpable mass in right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> fossa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less likely to have a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Barium <span class=\"customMeta\" data-dictid=\"981cb55fe1169277718759ac720c5d\">enema</span> finding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filling defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>\"Apple core\" </strong>lesion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5L9vKGCqgFAiWdxBpICx1748865496.mp3", "video": ""}, {"text": "Arrange the steps in the pathogenesis of colon cancer Dysplasia Intermediate adenoma DNA methylation 18q loss DCC", "options": [{"label": "A", "text": "1,3,2,4", "correct": true}, {"label": "B", "text": "1,2,3,4", "correct": false}, {"label": "C", "text": "4,3,2,1", "correct": false}, {"label": "D", "text": "3,2,1,4", "correct": false}], "correct_answer": "A. 1,3,2,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lkMede0cRrGGHfytrlb51740023578.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cTXeqCZ7wNldXeRFsss71748865349.mp3", "video": ""}, {"text": "A 62-year-old male with a history of long-standing ulcerative colitis presents with rectal bleeding, unintentional weight loss, and altered bowel habits. A colonoscopy reveals a large, ulcerated mass in the sigmoid colon, and a biopsy confirms adenocarcinoma. Which of these factors in his history would not have served as risk factors for developing colon cancer?", "options": [{"label": "A", "text": "Long-standing ulcerative colitis", "correct": false}, {"label": "B", "text": "Smoking", "correct": false}, {"label": "C", "text": "Use of NSAIDs", "correct": true}, {"label": "D", "text": "Red meat in the diet", "correct": false}], "correct_answer": "C. Use of NSAIDs", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dietary Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High red meat<strong> (Option D)</strong></li>\n<li>Low dietary fiber intake</li>\n<li>High-fat diet</li>\n<li>Alcohol consumption</li>\n<li>Cigarette smoking <strong>(Option B)</strong></li>\n<li>Lack of dietary vitamins A, C, E, and zinc</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">polyposis</span> (FAP)</li>\n<li>Gardner's syndrome</li>\n<li>Turcot's syndrome</li>\n<li>Family history of <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer (2-4 times increased risk)</li>\n<li>Hereditary nonpolyposis <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer (HNPCC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis<strong> </strong><strong>(Option A)</strong></li>\n<li>Crohn's disease (less risk compared to <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis)</li>\n<li>History of cholecystectomy</li>\n<li>Ileal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (increased <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> salts)</li>\n<li>Radiation exposure (mucinous type)</li>\n<li>Ureterosigmoidostomy (100-500 times increased risk)</li>\n<li>Acromegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PROTECTIVE FACTORS</strong></p>\n</td>\n<td style=\"border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-fiber diet</li>\n<li>Dietary calcium</li>\n<li>Aspirin and other NSAIDs<strong> (Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/g9mPDoGcbQMSdOxGKBou1748865217.mp3", "video": ""}, {"text": "Which of the following is the most accurate screening method for colon cancer?", "options": [{"label": "A", "text": "Flexible sigmoidoscopy", "correct": false}, {"label": "B", "text": "Colonoscopy", "correct": true}, {"label": "C", "text": "Fecal Occult Blood Test", "correct": false}, {"label": "D", "text": "Virtual Colonoscopy", "correct": false}], "correct_answer": "B. Colonoscopy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Screening Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fecal <span class=\"customMeta\" data-dictid=\"c8d9b6cbbb1692777194c4bc31f01f\">Occult</span> Blood Test (FOBT) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nonspecific</li>\n<li>Detects <span class=\"customMeta\" data-dictid=\"b3434346d71692777195b113bbab37\">peroxidase</span> activity in hemoglobin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple and non-invasive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low specificity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flexible <span class=\"customMeta\" data-dictid=\"bcae8561fa16927771989814c536d0\">Sigmoidoscopy</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Once every 5 years to identify adenomas, often combined with FOBT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct visualisation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited to the lower colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colonoscopy </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most accurate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comprehensive and therapeutic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bowel preparation</li>\n<li>Invasive</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air Contrast <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">Barium</span> Enema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects polyps larger than 1 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-invasive</li>\n<li>Can evaluate the entire colon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less accurate in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT <span class=\"customMeta\" data-dictid=\"eea4d02e60169277718415712391b7\">Colonography</span> (Virtual Colonoscopy) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helical <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> that creates 3D images of the colon's interior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-invasive</li>\n<li>Detailed imaging</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> preparation</li>\n<li>Air insufflation</li>\n<li>Radiation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/in39S5e6tbMeQ63fhrwZ1748865056.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "During ward rounds, you encounter a patient who has been admitted with esophageal carcinoma. What is the most likely presentation for this patient?", "options": [{"label": "A", "text": "Dysphagia of liquids followed by solids", "correct": false}, {"label": "B", "text": "Dysphagia of solids followed by liquids", "correct": true}, {"label": "C", "text": "Chest pain", "correct": false}, {"label": "D", "text": "Neck mass", "correct": false}], "correct_answer": "B. Dysphagia of solids followed by liquids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Carcinoma Esophagus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Squamous Cell Carcinoma</li>\n<li>Adenocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Squamous Cell Carcinoma: Smoking, Alcohol, Hot beverages, N-nitroso foods,</li>\n<li>Adenocarcinoma: <strong>Obesity, <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">Gastroesophageal</span> reflux, Barrett's esophagus</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive <strong>dysphagia (initially for solids followed by liquids), Anorexia, Weight loss</strong>, Odynophagia, and Regurgitation.</li>\n<li>Advanced symptoms: Hoarseness, Aspiration, Choking, etc.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endoscopy: Tumor visualisation, Biopsies, Chromoendoscopy, NBI</li>\n<li>Barium contrast study: Tumor as ulcerated/stenotic lesion</li>\n<li>Bronchoscopy: Check <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> spread</li>\n<li>Endoscopic &amp; <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> Ultrasonography:\n\t\t\t\t<ul>\n<li>EUS for <strong>staging tumour (T stage) and <span class=\"customMeta\" data-dictid=\"d420f34d5816927771943f346531fc\">para</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> nodes</strong> <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> of <strong>cervical nodes with FNA</strong></li>\n</ul>\n</li>\n<li>CT scan: <strong>Distant <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> assessment </strong></li>\n<li>FDG-PET scan: Detects nodes/metastases, not for tumour staging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient with peptic ulcer disease presents with persistent abdominal pain despite treatment at multiple hospitals. He has ulcers in the jejunum and ileum. His gastric pH is &amp;lt;2, and after discontinuing PPIs, his gastrin levels are 10 times higher than normal. What is the likely lesion, and what are the boundaries of the triangle containing it?", "options": [{"label": "A", "text": "Insulinoma; triangle formed", "correct": false}, {"label": "B", "text": "Insulinoma; triangle formed by cystic duct, junction of D2-D3, neck and body of pancreas", "correct": false}, {"label": "C", "text": "Gastrinoma; triangle formed by cystic duct, junction of D2-D3, neck and body of pancreas", "correct": true}, {"label": "D", "text": "Gastrinoma; triangle formed by only common bile duct, junction of D2-D3, neck and body of pancreas", "correct": false}], "correct_answer": "C. Gastrinoma; triangle formed by cystic duct, junction of D2-D3, neck and body of pancreas", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An intern assists in laparoscopic surgery, and the resident explains the instruments and operating ports. The surgeon then asks, \"What is the angle between the camera port and the working port called?\"", "options": [{"label": "A", "text": "Azimuth's angle", "correct": true}, {"label": "B", "text": "Elevation angle", "correct": false}, {"label": "C", "text": "Crossing angle", "correct": false}, {"label": "D", "text": "Manipulation angle", "correct": false}], "correct_answer": "A. Azimuth's angle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SmBLn4xrw9DRLNlcnrQp1741856180.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Angles of laparoscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Azimuth angle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is the angle between the <strong>camera port</strong> and the <strong>working port</strong> in <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> surgery; the ideal azimuth angle is between 30 - 45° to avoid clashing of the instruments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manipulation angle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is the angle between two working ports, and the ideal angle for this is 60°.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevation angle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This term is more related to the vertical positioning of instruments or the camera in relation to the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> field, not the angle between ports; the ideal angle for this is also 60°.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/SmBLn4xrw9DRLNlcnrQp1741856180.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Truelove and Witts classification used for?", "options": [{"label": "A", "text": "Acute severe ulcerative colitis", "correct": true}, {"label": "B", "text": "ARDS", "correct": false}, {"label": "C", "text": "Acute encephalitis", "correct": false}, {"label": "D", "text": "Acute pancreatitis", "correct": false}], "correct_answer": "A. Acute severe ulcerative colitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Truelove and Witts <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong><strong>for <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> Colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Stool Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Systemic Symptoms and signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;4 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> signs of toxicity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;4 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, Elevated ESR, CRP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;6 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, tachycardia, anaemia, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> illness, hypoalbuminemia, Elevated ESR, CRP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fulminant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10 stools/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous bleeding, fever, tachycardia, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> &amp; distension, “Toxic megacolon” (progressive <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> dilation, an indication for emergency surgery) in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following diseases with their respective gene mutation: A. Familial adenomatous polyposis i. SMAD4 B. Juvenile polyposis ii. STK11 C. Tuberous sclerosis iii. APC gene D. Peutz-Jeghers syndrome iv. TSC1", "options": [{"label": "A", "text": "A-i, B-ii, C-iii, D-iv", "correct": false}, {"label": "B", "text": "A-ii, B-iii, C-i, D-iv", "correct": false}, {"label": "C", "text": "A-iii, B-i, C-iv, D-ii", "correct": true}, {"label": "D", "text": "A-iv, B-ii, C-iii, D-i", "correct": false}], "correct_answer": "C. A-iii, B-i, C-iv, D-ii", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A. <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">Familial</span> <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>iii. <strong>APC gene</strong></p>\n<ul>\n<li>It is an <strong>a</strong><strong>utosomal dominant disorder </strong>caused by <strong>APC</strong> gene mutations on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 5.</li>\n<li>It is characterised by <strong>numerous intestinal polyps,</strong> which, if left untreated, have a h<strong>igh risk of developing <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B. <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> polyposis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>i. <strong>SMAD4 </strong></p>\n<ul>\n<li>It is also an <strong>autosomal</strong><strong> dominant disorder </strong>that commonly affects <strong>children under 5 years of </strong>age,</li>\n<li>It is characterised by <strong>pedunculated polyps,</strong> usually less than 3 cm in diameter.</li>\n<li>It is <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to mutations in the <strong>SMAD4 and BMPR1A genes</strong>, part of the TGF-β signalling pathway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C. <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">Tuberous</span> sclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>iv. <strong>TSC1</strong></p>\n<ul>\n<li>It is a <strong>neurocutaneous disorder</strong> resulting from mutations in the <strong>TSC1</strong> (hamartin) or <strong>TSC2</strong> (tuberin) genes.</li>\n<li>Patients exhibit neurological symptoms like seizures, along with skin abnormalities.</li>\n<li>The syndrome also includes <span class=\"customMeta\" data-dictid=\"d10905c64d1692777188b6730d6517\">hamartomatous</span> polyps in the intestine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D. Peutz-Jeghers syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ii. <strong>STK11</strong></p>\n<ul>\n<li>It is also an <strong>autosomal dominant disorder</strong> caused by a<strong> <span class=\"customMeta\" data-dictid=\"679634d4541692777191db4e3ade84\">loss-of-function mutation</span> in the </strong><strong>STK11 gene</strong><strong>.</strong></li>\n<li>It presents around 11 years of age and is characterised by\n\t\t\t\t<ul>\n<li><strong>Gastrointestinal <span class=\"customMeta\" data-dictid=\"d10905c64d1692777188b6730d6517\">hamartomatous</span> polyps, </strong>especially in the small intestine</li>\n<li><strong>Mucocutaneous hyperpigmentation</strong> (macules on lips, nostrils, <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> mucosa, and extremities).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old boy was brought to the emergency department with complaints of melena that contains gastric mucosa and acute intermittent pain in the right iliac region. On surgical exploration, the following structure was found, what is the diagnosis?", "options": [{"label": "A", "text": "Meckel's diverticulum", "correct": true}, {"label": "B", "text": "Appendicular lump", "correct": false}, {"label": "C", "text": "Carcinoid", "correct": false}, {"label": "D", "text": "Obstructed bowel loops", "correct": false}], "correct_answer": "A. Meckel's diverticulum", "question_images": ["https://image.prepladder.com/content/0Fs38ypib0HpzqMZeIa91741111424.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital true <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> of the small intestine, resulting from the incomplete <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of the <span class=\"customMeta\" data-dictid=\"4df1564f3c1692777202da97b54e7e\">vitelline</span> duct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rule of 2’s</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2% population, 2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> from the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> valve, 2 inches in length, 2 types of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> tissue (gastric, pancreatic), 2 years most common presentation, 2:1 male predominance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (melena), intestinal obstruction, diverticulitis, volvulus, intussusception.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Meckel’s scan (Tc-99m <span class=\"customMeta\" data-dictid=\"1771fe713b169277719506679fa243\">pertechnetate</span> scan for <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (diverticulectomy or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> resection) if symptomatic.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with grade 4 hemorrhoids underwent surgery, identify the instrument.", "options": [{"label": "A", "text": "Haemorrhoids resection kit", "correct": false}, {"label": "B", "text": "Stapler kit", "correct": false}, {"label": "C", "text": "Haemorrhoids band kit", "correct": true}, {"label": "D", "text": "CO2 laser", "correct": false}], "correct_answer": "C. Haemorrhoids band kit", "question_images": ["https://image.prepladder.com/content/jHrsvAfCw6t7A1xkydIE1741111486.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade of Hemorrhoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1</strong> (No prolapse)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lifestyle modification, fiber, sitz bath, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> agents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2</strong> (Prolapse, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> reduction)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rubber band ligation, sclerotherapy, <span class=\"customMeta\" data-dictid=\"82df9c600116927771907b7977a3b4\">infrared</span> coagulation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3</strong> (Prolapse, manual reduction needed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rubber band ligation, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> if persistent symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 4</strong> (Irreducible prolapse)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical options: <span class=\"customMeta\" data-dictid=\"688498a587169277718835ead0f24e\">Hemorrhoidectomy</span> (excision or stapler), laser hemorrhoidoplasty</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old male presents with sudden onset acute abdominal pain , constipation for 1 day , persistent hiccups , and occasional vomiting . An abdominal X-ray was performed. Identify the pathology.", "options": [{"label": "A", "text": "Sigmoid volvulus", "correct": true}, {"label": "B", "text": "Caecal volvulus", "correct": false}, {"label": "C", "text": "Intussusception", "correct": false}, {"label": "D", "text": "Dynamic obstruction", "correct": false}], "correct_answer": "A. Sigmoid volvulus", "question_images": ["https://image.prepladder.com/content/Yw1ZeYZhWd6f3QV3hMzU1741070969.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid Volvulus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caecal Volvulus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> on its mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"603036123f1692777183f87e582e3e\">caecum</span> &amp; <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Coffee bean\" or \"Omega loop\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Comma\" or \"Kidney bean\" sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel Dilatation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sigmoid <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> massively distended</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated caecum, displaced medially</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"dfd87633931692777186f47063d1c2\">detorsion</span> or surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery (right <span class=\"customMeta\" data-dictid=\"b8e6dbcc40169277718814cf80f864\">hemicolectomy</span> if gangrenous)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male undergoes an open appendectomy for acute appendicitis. The choice of incision was McBurney's incision. Postoperatively, after a few days, he presents with pain and bulging in the right lower quadrant, which is diagnosed as an indirect inguinal hernia. Which nerve injury during the appendectomy is most likely responsible for this complication?", "options": [{"label": "A", "text": "Ilioinguinal nerve", "correct": true}, {"label": "B", "text": "Femoral nerve", "correct": false}, {"label": "C", "text": "Genitofemoral nerve", "correct": false}, {"label": "D", "text": "Pudendal nerve", "correct": false}], "correct_answer": "A. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>MC <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complication</strong> involves infection at the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> site.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Intraabdominal abscess</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> within the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity, typically due to infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Ileus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary cessation of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function, leading to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension and discomfort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> leading to embolism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of blood clots in the veins, which can travel to the lungs or other parts of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> pyaemia (Pylephlebitis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, a rare but serious complication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> intestinal obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue causing <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction; <strong>MC late complication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Fecal fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage from the <span class=\"customMeta\" data-dictid=\"23c46c5fc916927771813b486e3774\">appendiceal</span> stump.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Nerve injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"108e66d0571692777189ff4a5e8740\">Ilioinguinal</span> nerve and <span class=\"customMeta\" data-dictid=\"240b25374316927771890d8646eda8\">iliohypogastric</span> nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of lower right abdominal pain and rebound tenderness in a patient with Meckel's diverticulum?", "options": [{"label": "A", "text": "Perforation", "correct": false}, {"label": "B", "text": "Intestinal obstruction", "correct": false}, {"label": "C", "text": "Appendicitis", "correct": true}, {"label": "D", "text": "Cholecystitis", "correct": false}], "correct_answer": "C. Appendicitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Endoscopic image show following finding what is the diagnosis?", "options": [{"label": "A", "text": "Barretts esophagus", "correct": false}, {"label": "B", "text": "Esophageal varices", "correct": true}, {"label": "C", "text": "Gastric erosion", "correct": false}, {"label": "D", "text": "Chronic GERD", "correct": false}], "correct_answer": "B. Esophageal varices", "question_images": ["https://image.prepladder.com/content/jikAIsqPH97EvQeNva7R1724928472.png"], "explanation_images": ["https://image.prepladder.com/content/N9aIF2xG1Lz8SiibXcNI1724928536.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;Esophageal&lt;/span&gt; v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with an umbilical hernia that was previously reducible but has now become irreducible. Which of the following is the most appropriate management option?", "options": [{"label": "A", "text": "Umblical excision", "correct": true}, {"label": "B", "text": "Umbilical excision with mesh hernioplasty", "correct": false}, {"label": "C", "text": "Mesh hernioplasty", "correct": false}, {"label": "D", "text": "Conservative management", "correct": false}], "correct_answer": "A. Umblical excision", "question_images": ["https://image.prepladder.com/content/qM3ALp7vsaWCa29pFM8H1724928697.png"], "explanation_images": ["https://image.prepladder.com/content/i0JA88oaopuLKvkDlxU31724929277.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A jeep driver presented with pain in the gluteal region along with swelling. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pilonidal sinus", "correct": true}, {"label": "B", "text": "Fistula in ano", "correct": false}, {"label": "C", "text": "Fissure in ano", "correct": false}, {"label": "D", "text": "Gluteal abscess", "correct": false}], "correct_answer": "A. Pilonidal sinus", "question_images": ["https://image.prepladder.com/content/iyh42yuThung6rt7Wo5z1724928909.png"], "explanation_images": ["https://image.prepladder.com/content/FgA02lUhVnAquyWUUesc1724851763.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"03c4278aff1692777195f7a3d87815\"&gt;Pilonidal&lt;/span&gt; sinu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the outpatient department (OPD) with recurrent diarrhea, abdominal pain, and foul-smelling stools. Colonoscopy following finding. what is the diagnosis?", "options": [{"label": "A", "text": "Pseudomembranous colitis", "correct": true}, {"label": "B", "text": "FAP", "correct": false}, {"label": "C", "text": "Ulcerative colitis", "correct": false}, {"label": "D", "text": "Acute gastritis", "correct": false}], "correct_answer": "A. Pseudomembranous colitis", "question_images": ["https://image.prepladder.com/content/AwtdnPBjGlnEKPVph3iq1724934834.png"], "explanation_images": ["https://image.prepladder.com/content/9IOTxRWvydAKkS1RmdgM1724934948.png"], "explanation": "<p>Correct Option A - Pseudomembranou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure commonly performed in patients with recurrent gastroesophageal reflux disease (GERD):", "options": [{"label": "A", "text": "360-degree Nissen fundoplication", "correct": true}, {"label": "B", "text": "Partial gastrectomy", "correct": false}, {"label": "C", "text": "Esophageal banding", "correct": false}, {"label": "D", "text": "270-degree Nissen fundoplication", "correct": false}], "correct_answer": "A. 360-degree Nissen fundoplication", "question_images": ["https://image.prepladder.com/content/suxu8Ejkc3Pq4mCVIdW01724935064.JPG"], "explanation_images": ["https://image.prepladder.com/content/S8b2tqxWD235yp1kSzzl1724916672.png", "https://image.prepladder.com/content/Vese8Dg7W5aYbC7IGSxO1724935788.png"], "explanation": "<p>Correct Option A - 360-degree Nissen fu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with recurrent vomiting undergoes an x-ray, as shown below. What is the most likely electrolyte imbalance in this patient?", "options": [{"label": "A", "text": "Hypokalemia", "correct": true}, {"label": "B", "text": "Hyperkalemia", "correct": false}, {"label": "C", "text": "Hyponatremia", "correct": false}, {"label": "D", "text": "Hypernatremia", "correct": false}], "correct_answer": "A. Hypokalemia", "question_images": ["https://image.prepladder.com/content/O36rOcwSGSGP6KM92Mtl1747288606.png"], "explanation_images": ["https://image.prepladder.com/content/YUK36wfWiBJOLpqs6wCI1747289079.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is most commonly injured during indirect inguinal hernia surgery?", "options": [{"label": "A", "text": "Femoral nerve", "correct": false}, {"label": "B", "text": "Genitofemoral nerve", "correct": false}, {"label": "C", "text": "Obturator nerve", "correct": false}, {"label": "D", "text": "Ilioinguinal nerve", "correct": true}], "correct_answer": "D. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery for pilonidal sinus, which type of flap is used in this surgery?", "options": [{"label": "A", "text": "Rhomboid flap", "correct": true}, {"label": "B", "text": "Advanced flap", "correct": false}, {"label": "C", "text": "Rotational flap", "correct": false}, {"label": "D", "text": "Free flap", "correct": false}], "correct_answer": "A. Rhomboid flap", "question_images": ["https://image.prepladder.com/content/pQPEHeZXdELjqSkIl7Pd1747291826.png"], "explanation_images": ["https://image.prepladder.com/content/opbEdlP5pGQeyKLVjqYP1747291908.png", "https://image.prepladder.com/content/qH8XKBw2Dg5m8mgVOqJC1747291963.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conservative Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For mild cases: cleaning, hair removal, and <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> maintenance.</li>\n<li>Cauterization with silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> or laser in less complex cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drainage through a small <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the abscess.</li>\n<li>Thorough cleaning of the <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to remove <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue and hair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedures include:</strong></p>\n<ul>\n<li>Laying open <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracks (with/without marsupialisation)</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (with/without primary closure)</li>\n<li>Off-midline <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> techniques (Limberg, Z-plasty, Karydakis procedures).</li>\n<li>Bascom Procedure: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> to clean the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> cavity, <span class=\"customMeta\" data-dictid=\"e0b35b76f816927771875efaec6acd\">excise</span> midline pits, and leave <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wounds open to heal secondarily.</li>\n<li>Flap Procedures: Used if initial treatments fail or if the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> recurs.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which incision is most commonly used for an appendectomy?", "options": [{"label": "A", "text": "McBurney incision", "correct": true}, {"label": "B", "text": "Kocher's incision", "correct": false}, {"label": "C", "text": "Midline incision", "correct": false}, {"label": "D", "text": "Battle incision", "correct": false}], "correct_answer": "A. McBurney incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CgtcNXgd1pkVpyx4GYMe1747643207.png", "https://image.prepladder.com/notes/fOfqrF97XFHyXGtDldnX1747643237.png", "https://image.prepladder.com/notes/9HWOfprnxAHiWMkOiMx41747643257.png", "https://image.prepladder.com/notes/JMnX7miHzgCRbsc4iKNn1747643275.png", "https://image.prepladder.com/notes/dGvpXlVgBni5yLvMagY31747643292.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Incision Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Common Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Abdominal Incisions</strong></p>\n<p style=\"text-align: center;\"><img alt=\"Abdominal incisions 2\" data-author=\"\" data-hash=\"12929\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"394\" src=\"https://image.prepladder.com/notes/fOfqrF97XFHyXGtDldnX1747643237.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Midline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Longitudinal cut through the <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba, <span class=\"customMeta\" data-dictid=\"1ad3dee7d11692777183c0670e32a1\">bloodless</span> access</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Exploratory laparotomy, trauma surgery, emergency surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Periumbilical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incisions around the umbilicus, avoiding the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> stalk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Laparoscopy, <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repairs, <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> ligation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pararectus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Along the <span class=\"customMeta\" data-dictid=\"7a23f5d3cd16927771982eb39c68c1\">semilunar</span> line, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> abdominis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Abdominal wall <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repairs, <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> creation, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Paramedian</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba, access to <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> viscera</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> structures,</p>\n<p>Reduced <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Kocher/Subcostal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inferior and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"ece2c20c001692777185d9ca0c08db\">costal</span> margin, access to upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Gallbladder, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, pancreas, liver transplants, epigastric surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Grindiron/</strong></p>\n<p><strong>McBurney/</strong></p>\n<p><strong>Lanz</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> incisions, typically for appendectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Appendectomy (right side), <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"c8de4db86c16927771862eeef04df3\">diverticulitis</span> (left side), <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appendectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracoabdominal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>From 7th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space to the umbilicus, exposes <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Retroperitoneal masses, pleural space, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> esophagus, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Thoracic Incisions</strong></p>\n<p style=\"text-align:center\"><img alt=\"Thoracic incisions\" data-author=\"\" data-hash=\"12930\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"277\" src=\"https://image.prepladder.com/notes/9HWOfprnxAHiWMkOiMx41747643257.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Access to <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> structures, various approaches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lung transplants, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> surgeries, trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Median Sternotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> dividing the sternum, wide access to the mediastinum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Open-heart surgery, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> tumor resection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Trapdoor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Complex incision, supraclavicular, sternal, and <span class=\"customMeta\" data-dictid=\"38764530ef16927772005496ff59a5\">thoracotomy</span> components</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Penetrating trauma, aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> aneurysms, complex <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> access</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Infraclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>A <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> just below the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> for <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessel access</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Thoracic outlet syndrome, <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessel surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Supraclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superior to the clavicle, providing access to the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Trauma, <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Neck Incisions</strong></p>\n<p style=\"text-align:center\"><img alt=\"Neck incisions\" data-author=\"\" data-hash=\"12931\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"514\" src=\"https://image.prepladder.com/notes/JMnX7miHzgCRbsc4iKNn1747643275.png\" width=\"600\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Collar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incision above the sternal <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> for <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> surgeries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Thyroid surgery, mid-neck structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Traumatic Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Along the <span class=\"customMeta\" data-dictid=\"ebf38dd1b416927771994e550b0d1e\">sternocleidomastoid</span> muscle for trauma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vascular or <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> neck injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Tracheostomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical/horizontal <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> superior to the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> for tracheostomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Airway management in patients needing long-term ventilation</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Pelvic Incisions</strong></p>\n<p style=\"text-align:center\"><img alt=\"Pelvic incisions\" data-author=\"\" data-hash=\"12932\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"327\" src=\"https://image.prepladder.com/notes/dGvpXlVgBni5yLvMagY31747643292.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pfannenstiel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transverse <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> above the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cesarean section, pelvic, urologic, and <span class=\"customMeta\" data-dictid=\"2a73ca8f1b16927771949cec7c59cc\">orthopaedic</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Maylard/Cherney</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle, provides access to <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Hysterectomy, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection, lower <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Inguinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair, urologic surgeries (cryptorchidism, varicocele)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>McEvedy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Femoral <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair (obsolete now due to high <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Gibson</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above inguinal ligament, <span class=\"customMeta\" data-dictid=\"2207398c591692777182d7ac096dbc\">arc</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Kidney transplantation, <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> access (iliac vessels, ureter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old male with a history of multiple episodes of vomiting, binge drinking, and heavy meals presents to the emergency department with sudden onset of severe left-sided chest pain radiating to the left shoulder. Pneumoperitoneum is noted on X-ray. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Mediastinal air leak", "correct": false}, {"label": "B", "text": "Esophageal perforation", "correct": true}, {"label": "C", "text": "Pneumoperitoneum", "correct": false}, {"label": "D", "text": "Peptic ulcer", "correct": false}], "correct_answer": "B. Esophageal perforation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0gI7BBSgf6oKJ27Petjn1747644174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Esophageal perforation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A breach in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall leads to leakage and increased <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iatrogenic injury, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> (Boerhaave's syndrome), foreign bodies, <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances, <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> esophagitis, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Varies by cause and location:</li>\n<li>Iatrogenic (recent instrumentation)</li>\n<li>Boerhaave's (vomiting, chest pain, emphysema)</li>\n<li>Cervical (neck pain, etc.)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging: Chest X-ray, contrast swallow studies, CT scan</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Boerhaave syndrome\" data-author=\"Fatt Yang Chew and Su-Tso Yang\" data-hash=\"12935\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.cmaj.ca/content/193/38/e1499\" data-tags=\"May2025\" height=\"404\" src=\"https://image.prepladder.com/notes/0gI7BBSgf6oKJ27Petjn1747644174.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seal perforation, ensure drainage, supportive measures (nutrition, <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">cardiorespiratory</span> support, <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> control)</li>\n<li>Conservative Management: Suitable for stable patients: antibiotics, nil by mouth, observation</li>\n<li>Endoscopic Interventions: Visualization, retrieval, sealing with clips/stents, <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube placement</li>\n<li>Surgical Intervention: Required for significant sepsis, large perforations, pleural involvement, delayed presentation</li>\n<li>Surgical Options: Primary repair, controlled <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> creation, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> diversion, <span class=\"customMeta\" data-dictid=\"5871c6089b1692777187961e72bc82\">esophagectomy</span> (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an indication for splenectomy?", "options": [{"label": "A", "text": "Iatrogenic splenic trauma", "correct": false}, {"label": "B", "text": "Thrombocytopenia", "correct": false}, {"label": "C", "text": "Hairy cell leukemia", "correct": false}, {"label": "D", "text": "Bone marrow failure", "correct": true}], "correct_answer": "D. Bone marrow failure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient presents with a left groin swelling for a few years, which increases in size on standing and decreases when lying down. On examination, the swelling shows a positive cough impulse. What is the appropriate management?", "options": [{"label": "A", "text": "Incision and drainage", "correct": false}, {"label": "B", "text": "Herniotomy", "correct": false}, {"label": "C", "text": "Herniorrhaphy", "correct": false}, {"label": "D", "text": "Reduction of contents, repair defects and reinforcement with mesh", "correct": true}], "correct_answer": "D. Reduction of contents, repair defects and reinforcement with mesh", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qgvD4NcaPSRiHWHANiB51747294287.png", "https://image.prepladder.com/content/uXi7wWMOXcAoMyOKzkfl1747294293.png", "https://image.prepladder.com/content/KcQvLLOhldeJpAv9EI4a1747294305.png", "https://image.prepladder.com/content/kHOHpxes6xL6KD16c7HS1747294314.png", "https://image.prepladder.com/content/GnRCYgXrVcigyk88Iqca1747294327.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"608\" src=\"https://image.prepladder.com/content/qgvD4NcaPSRiHWHANiB51747294287.png\" width=\"408\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shouldice Repair </strong>involves a four-layer repair (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Kumar hari rajah M. Somanathan \"' data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"290\" src=\"https://image.prepladder.com/content/uXi7wWMOXcAoMyOKzkfl1747294293.png\" width=\"408\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TEP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TAPP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery done <strong>above the</strong> peritoneum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery done<strong> beneath the</strong> peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and peritoneal complications.</li>\n<li>Reduced risk of adhesions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Larger working space</li>\n<li>Better visualisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smaller working spaces can make the procedure more technically challenging.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A higher risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> formation due to entry into the peritoneal cavity.</li>\n<li>Potential for increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain compared to TEP.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures does not form the boundary of Hesselbach's triangle?", "options": [{"label": "A", "text": "Inferior epigastric artery", "correct": false}, {"label": "B", "text": "Vas deferens", "correct": true}, {"label": "C", "text": "Rectus abdominis", "correct": false}, {"label": "D", "text": "Inguinal ligament", "correct": false}], "correct_answer": "B. Vas deferens", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/8ktafeIaZyil9IKU6pjo1747644781.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of hernia in which the internal organ forms a portion of the wall of the hernia sac?", "options": [{"label": "A", "text": "Lumbar hernia", "correct": false}, {"label": "B", "text": "Sliding hernia", "correct": true}, {"label": "C", "text": "Spigelian hernia", "correct": false}, {"label": "D", "text": "Richter hernia", "correct": false}], "correct_answer": "B. Sliding hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/rI6t31SgspxXpFkuSnOt1747644898.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the ER with complaints of epigastric pain for 1 day. On examination, his heart rate is 120/min, and blood pressure is 100/60 mmHg. There is tenderness, guarding, and rigidity on palpation. Based on the clinical presentation and the X-ray findings, what is the most likely cause of this patient's condition?", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": false}, {"label": "B", "text": "Hollow viscus perforation", "correct": true}, {"label": "C", "text": "Sigmoid volvulus", "correct": false}, {"label": "D", "text": "Small bowel obstruction", "correct": false}], "correct_answer": "B. Hollow viscus perforation", "question_images": ["https://image.prepladder.com/content/nl5AQfQJxW6sesxm4fm11747296933.png"], "explanation_images": ["https://image.prepladder.com/content/uNyKPjoNYv0M7iJ2yRu11747296968.png", "https://image.prepladder.com/content/VP5nZaIPZa7kyYNNPdZG1747296989.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During laparoscopic surgery, while inserting the trocar, which of the following is most prone to injury?", "options": [{"label": "A", "text": "Abdominal aorta", "correct": false}, {"label": "B", "text": "Superior epigastric artery", "correct": false}, {"label": "C", "text": "Both superior and inferior epigastric arteries", "correct": true}, {"label": "D", "text": "Inferior epigastric artery", "correct": false}], "correct_answer": "C. Both superior and inferior epigastric arteries", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with diffuse abdominal pain. Physical examination reveals rigidity and guarding. Abdominal X-ray shows air under the diaphragm. The patient is taken up for surgery, and an ileal perforation is noted intraoperatively with gross contamination of the abdomen with enteric and purulent content. What is the appropriate management of this patient?", "options": [{"label": "A", "text": "Resection and anastomosis", "correct": false}, {"label": "B", "text": "Primary repair", "correct": false}, {"label": "C", "text": "Urgent surgical exploration with ileostomy", "correct": true}, {"label": "D", "text": "Omental patch closure", "correct": false}], "correct_answer": "C. Urgent surgical exploration with ileostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CASd6vY9f5NF8SML82LW1747303010.png", "https://image.prepladder.com/content/VBNUip0gMpOHypo9AZXs1747303017.png", "https://image.prepladder.com/content/mkC8AxMVF7RgkzUcA4u11747303024.png", "https://image.prepladder.com/content/LLQA1mRYffKVBw4Bg5QK1747303030.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Common Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reversibility</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>End Colostomy</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/CASd6vY9f5NF8SML82LW1747303010.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single opening from the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> bowel. Often permanent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is removed or left in place, e.g., Hartmann's procedure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often permanent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Loop Ileostomy</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/VBNUip0gMpOHypo9AZXs1747303017.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loop of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is brought to the surface, and an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> is made</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Temporary diversion, especially in emergencies, and easily reversible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Double-barrel Colostomy</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/mkC8AxMVF7RgkzUcA4u11747303024.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two stomas are created: one for faecal output and one for <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> discharge</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely used; can be for cases requiring both <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and exteriorization, offering <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> fistula</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can be temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Permanent Ileostomy</strong></p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/LLQA1mRYffKVBw4Bg5QK1747303030.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Terminal <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> is brought to the surface after a colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when reconnection is not planned, often after total <span class=\"customMeta\" data-dictid=\"da1e89cf561692777196c1c93d4549\">proctocolectomy</span> for conditions like FAP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Permanent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female presents with a gradually progressive swelling over the abdomen for 1.5 years. She has a history of midline surgery. On examination, the swelling is 4 cm and is reducible with a palpable cough impulse. She is planning to undergo fascial closure with mesh repair. What is the most likely location of the mesh shown in the image?", "options": [{"label": "A", "text": "Inlay", "correct": false}, {"label": "B", "text": "Sublay", "correct": false}, {"label": "C", "text": "Onlay", "correct": true}, {"label": "D", "text": "Intraperitoneal repair", "correct": false}], "correct_answer": "C. Onlay", "question_images": ["https://image.prepladder.com/notes/SPl26PjJrgiOXJUPeYO61747649007.png"], "explanation_images": ["https://image.prepladder.com/content/1LrLHMMrnIzZgX7fhmVc1747303236.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mesh Placement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> itself</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh is sutured to the edges of the fascial defect.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be used for large defects where primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> isn't possible.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong> due to <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> separation from fascial edges under <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>On top of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath/external <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> aponeurosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous tissue is dissected off; the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is closed primarily, and the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed on top and secured</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically easier and less invasive.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher risk of <strong>seroma formation</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> infection, and skin necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retromuscular</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behind the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle but <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is opened, the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in the created space, and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is closed over it</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> well incorporated into tissues</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More complex procedure, <strong>risk of injury to <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> bundles.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preperitoneal</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peritoneum is separated from the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath; <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in this space, and the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> is closed over it.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> incorporation, <strong>lower risk of adhesions.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically challenging, risk of peritoneal tears.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common hernia in females?", "options": [{"label": "A", "text": "Direct Inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Obturator hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents to the clinic with complaints of food regurgitation and weight loss over the past several months. A barium swallow test is performed. What is the diagnosis?", "options": [{"label": "A", "text": "Achalasia cardia", "correct": true}, {"label": "B", "text": "Esophageal carcinoma", "correct": false}, {"label": "C", "text": "Zenker's diverticulum", "correct": false}, {"label": "D", "text": "Diffuse esophageal spasm", "correct": false}], "correct_answer": "A. Achalasia cardia", "question_images": ["https://image.prepladder.com/content/IapcBTqpKrWWBTbm8N9R1717763547.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"b032d2af58169277718080a9060b14\"&gt;Achalasia&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are risk factors for cholangiocarcinoma? Hepatitis B PSC Caroli's disease Opisthorchis viverrini", "options": [{"label": "A", "text": "1, and 2 only", "correct": false}, {"label": "B", "text": "2, 3, and 4 only", "correct": false}, {"label": "C", "text": "4 only", "correct": false}, {"label": "D", "text": "1, 2, 3, and 4", "correct": true}], "correct_answer": "D. 1, 2, 3, and 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 1, 2, 3, and 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old chronic alcoholic presents with severe hematemesis. USG shows distention of the portal vein and the liver appears hyperechoic. Pantoprazole has been initiated. What is the next appropriate step in management?", "options": [{"label": "A", "text": "Initiate a course of broad-spectrum antibiotics", "correct": false}, {"label": "B", "text": "Order a liver biopsy to assess for fibrosis", "correct": false}, {"label": "C", "text": "Administer intravenous fluids and electrolyte replacement", "correct": true}, {"label": "D", "text": "Perform an endoscopy to look for varices", "correct": false}], "correct_answer": "C. Administer intravenous fluids and electrolyte replacement", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Administer &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;intravenous&lt;/span&gt; fluids and &lt;span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\"&gt;electrolyte&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image given below?", "options": [{"label": "A", "text": "PEG tube", "correct": true}, {"label": "B", "text": "Central line", "correct": false}, {"label": "C", "text": "Orogastric tube insertion", "correct": false}, {"label": "D", "text": "ICD", "correct": false}], "correct_answer": "A. PEG tube", "question_images": ["https://image.prepladder.com/content/M17cQY0UNSbguxGWmZ9y1717995104.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9a1def52471692777195f66cc715bf\"&gt;PEG&lt;/span&gt; tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman presents with a history of decreased fetal movements and respiratory distress in her newborn. On examination, the neonate appeared cyanotic, with increased breathing work. Auscultation reveals bowel sounds in the left hemithorax. A chest x-ray is given in the image. Which of the following congenital anomalies is most likely responsible for these findings?", "options": [{"label": "A", "text": "Congenital diaphragmatic hernia", "correct": true}, {"label": "B", "text": "Tetralogy of Fallot", "correct": false}, {"label": "C", "text": "Transposition of the Great Vessels", "correct": false}, {"label": "D", "text": "Tracheoesophageal fistula", "correct": false}], "correct_answer": "A. Congenital diaphragmatic hernia", "question_images": ["https://image.prepladder.com/content/iNMQsnmNIxoT1ozg8ALl1747218524.png"], "explanation_images": ["https://image.prepladder.com/content/yrqBaj0tPzHF5TNX5AFY1747218569.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Bochdalek Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Morgagni Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Left-sided</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Right-sided</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Posterolateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Anteromedial</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Herniated Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Small intestine, stomach</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transverse colon, sometimes liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Scaphoid abdomen, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress, <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Mostly Asymptomatic and Incidental</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Pulmonary hypoplasia</li>\n<li>Pulmonary hypertension</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Less severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Polyhydramnios, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> LHR, and liver position</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Rarely detected prenatally; usually diagnosed later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Generally Better prognosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During an endoscopy, a man is found to have the squamocolumnar junction located more proximally than normal. Which of the following conditions is most likely responsible for this finding?", "options": [{"label": "A", "text": "Achalasia cardia", "correct": false}, {"label": "B", "text": "Sliding hernia", "correct": true}, {"label": "C", "text": "Rolling hernia", "correct": false}, {"label": "D", "text": "Gastroesophageal reflux disease", "correct": false}], "correct_answer": "B. Sliding hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GJbYd4M5Sf9V0Tk6MlCM1747218733.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I/Sliding Hiatus Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common type.</p>\n<p><strong>The <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> and part of the stomach slide up through the diaphragm.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II/Paraesophageal Hiatus Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Part of the stomach pushes through the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> next to the oesophagus. The <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> remains in place.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III/Mixed Hiatus Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Combines features of both sliding and <span class=\"customMeta\" data-dictid=\"dfb43383f5169277719429a15f12a6\">paraesophageal</span> hernias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves <span class=\"customMeta\" data-dictid=\"93943f6ee2169277720298325fd255\">viscera</span> other than the stomach in the hernial sac, like the colon.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which appendicular carcinoma is most commonly associated with pseudomyxoma peritonei?", "options": [{"label": "A", "text": "Mucinous cystadenoma", "correct": true}, {"label": "B", "text": "Adenocarcinoma", "correct": false}, {"label": "C", "text": "Carcinoid tumour", "correct": false}, {"label": "D", "text": "Serous cystadenoma", "correct": false}], "correct_answer": "A. Mucinous cystadenoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the treatment of choice in a pregnant woman with an anal wart, as shown in the image given below?", "options": [{"label": "A", "text": "Trichloroacetic acid application", "correct": false}, {"label": "B", "text": "Excision", "correct": false}, {"label": "C", "text": "Cryotherapy with liquid nitrogen", "correct": true}, {"label": "D", "text": "Oral acyclovir", "correct": false}], "correct_answer": "C. Cryotherapy with liquid nitrogen", "question_images": ["https://image.prepladder.com/content/vBJJF370vjqxHFVadFL11747384878.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male patient who underwent gastrointestinal surgery one month ago, presents with a palpable abdominal bulge at the surgical site. Physical examination reveals a reducible 12 cm incisional hernia. What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Schedule for laparoscopic mesh repair", "correct": true}, {"label": "B", "text": "Prescribe an abdominal belt for daily use", "correct": false}, {"label": "C", "text": "Advise observation and reassessment in six months", "correct": false}, {"label": "D", "text": "Laparoscopic closure without mesh", "correct": false}], "correct_answer": "A. Schedule for laparoscopic mesh repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zHuGpeIVK6jBBIbzlajK1747219716.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mesh Placement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> itself</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh is sutured to the edges of the fascial defect.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be used for large defects where primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> isn't possible.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong> due to <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> separation from fascial edges under <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>On top of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath/external <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> aponeurosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous tissue is dissected off; the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is closed primarily, and the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed on top and secured</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically easier and less invasive.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher risk of <strong>seroma formation</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> infection, and skin necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Retromuscular</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behind the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle but <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is opened, the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in the created space, and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is closed over it</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> well incorporated into tissues</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More complex procedure, <strong>risk of injury to <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> bundles.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Preperitoneal</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peritoneum is separated from <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in this space, <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> is closed over it.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> incorporation, <strong>lower risk of adhesions.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically challenging, risk of peritoneal tears.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate is diagnosed with gastroschisis. What is the most appropriate management strategy for this condition?", "options": [{"label": "A", "text": "Surgical wall repair", "correct": true}, {"label": "B", "text": "Wait and watch", "correct": false}, {"label": "C", "text": "Slowly putting it inside", "correct": false}, {"label": "D", "text": "Surgical excision", "correct": false}], "correct_answer": "A. Surgical wall repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wVaJWkwrfh92tLMbOzwW1747220030.png", "https://image.prepladder.com/content/vv7UpnpyCIXf4uDPB1l41747220036.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Omphalocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gastroschisis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents protrude through the <strong>base of the umbilicus</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is when <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents protrude through a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> typically located to the<strong> right of the umbilicus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Covering</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> organs are covered by two layers: <strong>Amnion (outer) and <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> (inner)</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> covers the exposed organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chromosomal abnormalities: </strong>Associated with Trisomy 13, 18, and 21.</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations affect multiple systems in the following order: <strong>cardiovascular&gt; Muscular&gt; gastrointestinal&gt; genitourinary. </strong>(Mnemonic: \"CM GIGU\")</li>\n<li><strong>Beckwith-Wiedemann Syndrome: </strong>Can include hemihypertrophy, macroglossia, visceromegaly, omphalocele, and increased risk of hepatoblastoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fewer chromosomal abnormalities compared to omphalocele.</li>\n<li>Higher risk of intestinal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> and dysfunction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally poor due to associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations, which are the most common cause of death.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally better than <span class=\"customMeta\" data-dictid=\"fc7e9c02921692777194319bbee508\">omphalocele</span> due to fewer associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> closure</strong> is preferred for small to medium-sized defects.</li>\n<li><strong>Larger defects</strong> may require:</li>\n<li><strong>Prosthetic patch closure</strong> (e.g., <strong>Gore-Tex</strong>),</li>\n<li><strong>Porcine small intestinal submucosa</strong>-derived biomaterials (e.g., <strong>Surgisis</strong>),</li>\n<li><strong>Skin <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> closure</strong>, or</li>\n<li><strong>Placement of a silo</strong> for <strong>sequential reduction</strong> and <strong>staged closure</strong>.</li>\n<li>For <strong>giant omphaloceles</strong>, <strong>topical application of <span class=\"customMeta\" data-dictid=\"0507a1a3f51692777187ca51264f84\">escharotic</span> agents</strong> like <strong>povidone-iodine (Betadine)</strong> <span class=\"customMeta\" data-dictid=\"25ee86538e1692777194ef5ba9e4f1\">ointment</span> or <strong>silver nitrate</strong> is used to thicken and <span class=\"customMeta\" data-dictid=\"51b54455da1692777187ef9039ace9\">epithelialize</span> the sac.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary closure</strong> is typically done under <strong>general anesthesia</strong> and often requires admission to the <strong>NICU</strong> for <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> ventilation.</li>\n<li>Alternatively, a <strong>preformed silo</strong> can be placed at the bedside for gradual reduction, sometimes avoiding the need for general <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> altogether.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"423\" src=\"https://image.prepladder.com/content/wVaJWkwrfh92tLMbOzwW1747220030.png\" width=\"423\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/content/vv7UpnpyCIXf4uDPB1l41747220036.png\" width=\"439\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image:", "options": [{"label": "A", "text": "Omphalocele", "correct": true}, {"label": "B", "text": "Urachal cyst", "correct": false}, {"label": "C", "text": "Umbilical hernia", "correct": false}, {"label": "D", "text": "Umbilical adenoma", "correct": false}], "correct_answer": "A. Omphalocele", "question_images": ["https://image.prepladder.com/content/UxAsgYTcHkokFVUfelhz1748277545.png"], "explanation_images": ["https://image.prepladder.com/content/wK1LWP7okOkqikk2ZicC1748277600.png", "https://image.prepladder.com/content/bepPEMBFAa9Rqp3nyv6m1748277823.png", "https://image.prepladder.com/content/2yQDwIOGNsg5WrqSMnhK1748277869.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a seat belt injury, which of the following organs is most commonly affected?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Spleen", "correct": false}, {"label": "C", "text": "Pancreas", "correct": false}, {"label": "D", "text": "Hollow viscus", "correct": true}], "correct_answer": "D. Hollow viscus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FaPpuzt5cN6uAsCEALsD1747385569.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient in the first decade of life presents with grade II splenic injury with no active bleeding. What is the management?", "options": [{"label": "A", "text": "Splenectomy", "correct": false}, {"label": "B", "text": "Splenorrhaphy", "correct": false}, {"label": "C", "text": "Embolization", "correct": false}, {"label": "D", "text": "Conservative", "correct": true}], "correct_answer": "D. Conservative", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>American Association for the Surgery of Trauma - AAST <span class=\"customMeta\" data-dictid=\"6a4861c8d71692777199aeb1d55c85\">Spleen</span> Injury scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade I (Minor Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> affects less than 10% of the splenic surface area.</li>\n<li>Capsular tear that is less than 1 cm in depth without active bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade II:</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-50% of the splenic surface area.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> less than 5 cm in diameter.</li>\n<li>Laceration between 1 and 3 cm in depth that doesn't involve trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade III:</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covering more than 50% of the splenic surface area or expanding hematoma.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> greater than 5 cm or expanding.</li>\n<li>Laceration is more than 3 cm in depth or involves trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade IV:</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Laceration affects <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> or hilar vessels, with evidence of devascularisation involving more than 25% of the spleen.</li>\n<li>Injury to the splenic <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> that results in major blood loss.</li>\n<li>Any injury in the presence of splenic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury or active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> within the splenic capsule</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade V (Severe Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Completely shattered spleen.</li>\n<li>Vascular injury involving the splenic <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> that results in complete <span class=\"customMeta\" data-dictid=\"ddadff81201692777186bff3a36612\">devascularization</span> of the spleen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for an adult male patient with a history of intermittent purulent discharge with a slight blood tinge from an external opening located in the perianal region?", "options": [{"label": "A", "text": "Hemorrhoids", "correct": false}, {"label": "B", "text": "Pilonidal sinus", "correct": false}, {"label": "C", "text": "Perianal abscess", "correct": false}, {"label": "D", "text": "Fistula in ano", "correct": true}], "correct_answer": "D. Fistula in ano", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7fxaLB3QNQjbapXAVZ5a1747227847.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>\n<p>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.</p>\n</li>\n<li>\n<p>Associated Conditions:</p>\n<ul>\n<li>\n<p>Crohn’s disease</p>\n</li>\n<li>\n<p>Tuberculosis</p>\n</li>\n<li>\n<p>Lymphogranuloma venereum</p>\n</li>\n<li>\n<p>Actinomycosis</p>\n</li>\n<li>\n<p>Rectal duplication</p>\n</li>\n<li>\n<p>Foreign bodies</p>\n</li>\n<li>\n<p>Malignancy (rare, can develop within a longstanding fistula)</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</p>\n</li>\n<li>\n<p>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</p>\n</li>\n<li>\n<p>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening, (indicative of a rectal rather than an anal internal opening).</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Inter- sphincteric (most common, 70%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Trans- sphincteric (25%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Supra- sphincteric (4%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Extra- sphincteric (1%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A barium swallow radiographic image of a woman with dysphagia is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Achalasia", "correct": true}, {"label": "B", "text": "Distal esophageal spasm", "correct": false}, {"label": "C", "text": "Jackhammer esophagus", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Achalasia", "question_images": ["https://image.prepladder.com/content/NiuTuWHhNf5G4MN5yH7M1747284621.png"], "explanation_images": ["https://image.prepladder.com/content/t6SKR9GKVAH60UlmZJTU1747284717.png", "https://image.prepladder.com/content/fgFwkYqlzEI5o78qi7dF1747284729.png", "https://image.prepladder.com/content/6tKjxNqLbzKvOLveJrLU1747386737.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Achalasia cardia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterised by the progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall. This leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> and failure of the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gold Standard: This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the esophagus. <strong>(Option A)</strong></p>\n<ul>\n<li>Elevated resting LES pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete LES relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the LES (Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Farnoosh Farrokhi, Michael F. Vaezi\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Acha.JPG\" data-tags=\"\" height=\"411\" src=\"https://image.prepladder.com/content/t6SKR9GKVAH60UlmZJTU1747284717.png\" width=\"208\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris, It is important to rule out other causes of dysphagia, such as tumors.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent bronchoscopy, during the procedure a perforation occurred at 25 cm. Which structure is most likely to be damaged?", "options": [{"label": "A", "text": "Diaphragm", "correct": false}, {"label": "B", "text": "Arch of aorta", "correct": true}, {"label": "C", "text": "Pharyngoesophageal junction", "correct": false}, {"label": "D", "text": "T10", "correct": false}], "correct_answer": "B. Arch of aorta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CjuJTpXLl1LPnB6ExFjE1747386907.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the operative procedure shown in the image.", "options": [{"label": "A", "text": "Primary closure of perforation", "correct": false}, {"label": "B", "text": "Resection and Anastomosis", "correct": true}, {"label": "C", "text": "Ileostomy", "correct": false}, {"label": "D", "text": "Resection alone", "correct": false}], "correct_answer": "B. Resection and Anastomosis", "question_images": ["https://image.prepladder.com/content/YEYJAxfWWh1PBD6hAenN1747387012.png"], "explanation_images": ["https://image.prepladder.com/content/e1wvZifhme9Ud2ZAVGs91747387024.png", "https://image.prepladder.com/content/VQ6xSg2es5Mq01O63G8m1747285429.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young female presents with pain and vomiting in the ER. Clinical examination reveals a swelling lateral and below the pubic tubercle. X-ray shows intestinal obstruction. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Adhesions", "correct": false}, {"label": "B", "text": "Strangulated Inguinal Hernia", "correct": false}, {"label": "C", "text": "Strangulated Femoral Hernia", "correct": true}, {"label": "D", "text": "Appendicular mass", "correct": false}], "correct_answer": "C. Strangulated Femoral Hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PDSDFJj4yt7U2k902FxI1745927732.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with complaints of dysphagia, halitosis, and regurgitation . Radiological imaging shows a blind pouch at the level of the pharynx. What is the likely diagnosis ?", "options": [{"label": "A", "text": "Pulsion diverticula", "correct": true}, {"label": "B", "text": "Achalasia cardia", "correct": false}, {"label": "C", "text": "CA Esophagus", "correct": false}, {"label": "D", "text": "GERD", "correct": false}], "correct_answer": "A. Pulsion diverticula", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"cf49aa21c616927771961992dfef4e\"&gt;Pulsion&lt;/span&gt; Diverticu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man, a smoker, presented to the OPD with complaints of fatigue. He is known to be anemic and his sister had a history of endometrial cancer. The physician is considering appropriate colorectal cancer screening methods for this patient. Which screening method should be recommended for colorectal malignancy in this patient?", "options": [{"label": "A", "text": "Barium enema", "correct": false}, {"label": "B", "text": "Colonoscopy every 10 years", "correct": true}, {"label": "C", "text": "Check for occult blood in stool", "correct": false}, {"label": "D", "text": "Flexible sigmoidoscopy yearly", "correct": false}], "correct_answer": "B. Colonoscopy every 10 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\"&gt;Colonoscopy&lt;/span&gt; ev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of material is in the mesh used in Lichtenstein hernioplasty?", "options": [{"label": "A", "text": "Polypropylene", "correct": true}, {"label": "B", "text": "Polyglactin", "correct": false}, {"label": "C", "text": "Polydioxanone", "correct": false}, {"label": "D", "text": "Polyacrilamide", "correct": false}], "correct_answer": "A. Polypropylene", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Polypropylene: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents with a 5-day history of abdominal pain, fever and vomiting . On examination, there is a palpable mass in right iliac fossa with leukocytosis . What is the management plan for this condition?", "options": [{"label": "A", "text": "Ochsner-Sherren regime", "correct": true}, {"label": "B", "text": "Alvarado scoring", "correct": false}, {"label": "C", "text": "Laparoscopic appendectomy", "correct": false}, {"label": "D", "text": "Cholecystectomy", "correct": false}], "correct_answer": "A. Ochsner-Sherren regime", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Ochsner-Sherren reg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn baby presents with bilious vomiting and abdominal distension within 2 days of birth . An X-ray abdomen was performed which is shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Duodenal atresia", "correct": true}, {"label": "B", "text": "Pyloric stenosis", "correct": false}, {"label": "C", "text": "Esophageal atresia", "correct": false}, {"label": "D", "text": "Gas in bowel", "correct": false}], "correct_answer": "A. Duodenal atresia", "question_images": ["https://image.prepladder.com/content/N6dne6ZO9SObHXyvupjE1692687072.png"], "explanation_images": [], "explanation": "<p>Correct option A - Du\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male patient presents with progressive dysphagia to solids and liquids and the manometry findings include uncoordinated or absent peristalsis with increased LES resting pressure . What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Stomach cancer", "correct": false}, {"label": "B", "text": "Cancer esophagus", "correct": false}, {"label": "C", "text": "GERD", "correct": false}, {"label": "D", "text": "Achalasia cardia", "correct": true}], "correct_answer": "D. Achalasia cardia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nZronbiGnnBBeTU2qrdf1697717318.png"], "explanation": "<p>Correct option D - &lt;span class=\"customMeta\" data-dictid=\"b032d2af58169277718080a9060b14\"&gt;Achalasia&lt;/span&gt; cardia \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents after undergoing a Billroth II gastrectomy operation and complains of symptoms suggestive of dumping syndrome , including vomiting and diarrhea occurring approximately 20 minutes after meals. What should be the initial management for this patient's condition?", "options": [{"label": "A", "text": "Low fat diet", "correct": false}, {"label": "B", "text": "Small frequent meals", "correct": true}, {"label": "C", "text": "Insulin and protein", "correct": false}, {"label": "D", "text": "Reverse Billroth II to Billroth I", "correct": false}], "correct_answer": "B. Small frequent meals", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - Small frequ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient is scheduled to undergo laparoscopic surgery. The surgical team plans to create a pneumoperitoneum to facilitate the procedure. Which gas is commonly used for creating the pneumoperitoneum in laparoscopic surgeries?", "options": [{"label": "A", "text": "Helium", "correct": false}, {"label": "B", "text": "Oxygen", "correct": false}, {"label": "C", "text": "Nitrogen", "correct": false}, {"label": "D", "text": "Carbon dioxide", "correct": true}], "correct_answer": "D. Carbon dioxide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient complains of loss of appetite and dysphagia, with a weight loss of approximately 6 kg over the last three months. He had a previous diagnosis of esophageal cancer and underwent treatment. What might be the cause of his current symptoms?", "options": [{"label": "A", "text": "Esophageal cancer recurrence", "correct": true}, {"label": "B", "text": "Fibrosis", "correct": false}, {"label": "C", "text": "Achalasia cardia", "correct": false}, {"label": "D", "text": "GERD", "correct": false}], "correct_answer": "A. Esophageal cancer recurrence", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Esophageal cancer recu\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>TNM <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of Oesophageal cancer</strong></td>\n</tr>\n<tr>\n<td>\n<p>T : Primary tumour</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tx : Tumour cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T0 : No evidence of primary tumour</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tis : <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">High-grade</span> dysplasia, defined as <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> cells confined to the <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> by the basement membrane</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T1 : Tumour invades the <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria, <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> mucosae or submucosa</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T1a : Tumour invades the <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria or <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> mucosae</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T1b : Tumour invades submucosa</p>\n</td>\n</tr>\n<tr>\n<td>T2 : Tumour invades the <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria</td>\n</tr>\n<tr>\n<td>\n<p>T3 : Tumour invades adventitia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T4 : Tumour invades the adjacent structures</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T4a : Tumour invades the pleura, pericardium, <span class=\"customMeta\" data-dictid=\"9e415033a51692777182914ea1a92e\">azygos</span> vein, <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> or peritoneum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T4b : Tumour invades other adjacent structures, such as the aorta, vertebral body or airway</p>\n</td>\n</tr>\n<tr>\n<td>N : Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</td>\n</tr>\n<tr>\n<td>Nx : Regional nodal status cannot be assessed</td>\n</tr>\n<tr>\n<td>N0 : No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</td>\n</tr>\n<tr>\n<td>N1 : <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in one or two regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</td>\n</tr>\n<tr>\n<td>N2 : <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in three to six regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</td>\n</tr>\n<tr>\n<td>N3 : <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in seven or more regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</td>\n</tr>\n<tr>\n<td>M : Distant metastases</td>\n</tr>\n<tr>\n<td>M0 : No distant metastasis</td>\n</tr>\n<tr>\n<td>M1 : Distant metastasis</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the position of the appendix marked in red colour?", "options": [{"label": "A", "text": "Retrocecal", "correct": true}, {"label": "B", "text": "Preileal", "correct": false}, {"label": "C", "text": "Subcecal", "correct": false}, {"label": "D", "text": "Pelvic", "correct": false}], "correct_answer": "A. Retrocecal", "question_images": ["https://image.prepladder.com/content/KXyaU2UiZLuBVS92g7T41745931701.png"], "explanation_images": ["https://image.prepladder.com/content/4NJVIiEJLjRAGIt7O7YC1744979059.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Retrocecal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May present with <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> or back pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subcecal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> gynaecological disorders or <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pre-ileal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Post-ileal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Paracecal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can present with typical right lower <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subhepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be mistaken for cholecystitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pelvic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> symptoms of <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease or ovarian pathology</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A surgeon examines a case of hernia and is able to retract the hernial sac but not its contents. Based on this examination, which type of hernia is most likely?", "options": [{"label": "A", "text": "Incarcerated hernia", "correct": false}, {"label": "B", "text": "Reduction en masse", "correct": true}, {"label": "C", "text": "Sliding hernia", "correct": false}, {"label": "D", "text": "Maydl's hernia", "correct": false}], "correct_answer": "B. Reduction en masse", "question_images": ["https://image.prepladder.com/content/t1ZMCePr193SmnrQJYoi1745931787.png"], "explanation_images": ["https://image.prepladder.com/content/QCrKMOuJ1hugH2kUt4Zq1745931794.png", "https://image.prepladder.com/content/YHnJDR7tdGlLrPM8hrSV1744979263.png", "https://image.prepladder.com/content/g1P8rqb32OsiSa7KqGsg1744979278.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old patient presents with a complaint of per rectal bleeding. The surgeon suspects a possible colorectal pathology and wants to determine the most appropriate investigation for this patient. Which of the following options would be the best choice?", "options": [{"label": "A", "text": "Colonoscopy", "correct": true}, {"label": "B", "text": "CEA levels", "correct": false}, {"label": "C", "text": "CA-19-9 levels", "correct": false}, {"label": "D", "text": "CECT", "correct": false}], "correct_answer": "A. Colonoscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a perineal approach for rectal prolapse?", "options": [{"label": "A", "text": "Altemeir", "correct": false}, {"label": "B", "text": "Frykman and Goldberg's", "correct": true}, {"label": "C", "text": "Thiersch", "correct": false}, {"label": "D", "text": "Delorme", "correct": false}], "correct_answer": "B. Frykman and Goldberg's", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Abdominal Rectopexy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Perineal Rectopexy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic or <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> rectopexy-anterior/ posterior- <strong>Well's, Ripstein</strong></li>\n<li>Suture rectopexy- <strong>Lahaut</strong></li>\n<li>Anterior Resection</li>\n<li>Resection Rectopexy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal sleeve <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (<strong>Delrome's</strong>) <strong>(Option D)</strong></li>\n<li>Perineal recto <span class=\"customMeta\" data-dictid=\"c571bd042816927771984a81e88895\">sigmoidectomy</span> (<strong>Altemeier's</strong>) <strong>(Option A)</strong></li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> of <strong>Lockhardt-Mummery </strong></li>\n<li><strong>Mickulicz Miles</strong> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> <span class=\"customMeta\" data-dictid=\"ebf9c40d2b16927772009a937efb25\">transanal</span> recto sigmoidectomy</li>\n<li>Anal encircling (<strong>Thiersch</strong>) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fixation of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> provides adequate tension to prevent recurrence.</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> options (laparoscopic or robotic) offer benefits in pain control, hospital stay, and recovery time</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lower <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality, suitable for elderly or medically unfit patients.</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires extensive <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> and fixation, which may have higher <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> (10%-33%).</li>\n<li>Risk of mesh-related complications such as erosion, infection, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, and migration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approaches</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common complication following ligation of the first vessel during abdominoperineal resection for rectal carcinoma?", "options": [{"label": "A", "text": "Parasympathetic - bladder dysfunction and retrograde ejaculation", "correct": false}, {"label": "B", "text": "Sympathetic - bladder dysfunction and impotence", "correct": false}, {"label": "C", "text": "Sympathetic - retrograde ejaculation and bladder dysfunction", "correct": true}, {"label": "D", "text": "Sympathetic - impotence and loss of cutaneous sensation in the perineal region", "correct": false}], "correct_answer": "C. Sympathetic - retrograde ejaculation and bladder dysfunction", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with right thigh pain after undergoing bilateral laparoscopic hernia repair for an inguinal hernia. Which nerve entrapment is most likely responsible for this symptom?", "options": [{"label": "A", "text": "Ilioinguinal nerve", "correct": false}, {"label": "B", "text": "Iliohypogastric nerve", "correct": false}, {"label": "C", "text": "Femoral nerve", "correct": false}, {"label": "D", "text": "Lateral cutaneous nerve of thigh", "correct": true}], "correct_answer": "D. Lateral cutaneous nerve of thigh", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Triangle of Doom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Triangle of Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Boundaries:</strong></p>\n<ul>\n<li><strong>Medial:</strong> <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">Vas</span> deferens</li>\n<li><strong>Lateral:</strong> Gonadal vessels</li>\n<li><strong>Base:</strong> Fold of peritoneum</li>\n<li><strong>Apex:</strong> Deep inguinal ring</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Boundaries:</strong></p>\n<ul>\n<li><strong>Medial:</strong> Gonadal vessels</li>\n<li><strong>Lateral: </strong>Fold of peritoneum</li>\n<li><strong>Superior:</strong> <span class=\"customMeta\" data-dictid=\"e0b3e69ab9169277718997e696a3ab\">Iliopubic</span> tract</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Content</strong>:</p>\n<p>Iliac vessels are located behind the peritoneal fold.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Content</strong>:<strong> </strong>(Medial to Lateral)</p>\n<ul>\n<li>Femoral nerve</li>\n<li>Femoral branch of the <span class=\"customMeta\" data-dictid=\"65280a763b1692777188eb28595e8b\">genitofemoral</span> nerve</li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Significance</strong>:</p>\n<p>Sharp <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> in this area risks damaging the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> vessels, which can lead to severe <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and potentially life-threatening complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Significance</strong>:</p>\n<ul>\n<li>Potential risk of nerve damage if <span class=\"customMeta\" data-dictid=\"d4991429ac169277718750e171fb86\">electrocautery</span> is used.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</strong> is the<strong> most commonly injured nerve.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with swelling in the groin region, diagnosed as a direct inguinal hernia . Weakness in which of the following structures is most likely to cause this condition?", "options": [{"label": "A", "text": "Pectineal ligament", "correct": false}, {"label": "B", "text": "Conjoint tendon", "correct": true}, {"label": "C", "text": "Reflected part of inguinal ligament", "correct": false}, {"label": "D", "text": "Lacunar ligament", "correct": false}], "correct_answer": "B. Conjoint tendon", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child presents with a rectal polyp and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. The child is diagnosed with a juvenile rectal polyp. Which of the following best describes the polyp in this case?", "options": [{"label": "A", "text": "Adenoma", "correct": false}, {"label": "B", "text": "Choristoma", "correct": false}, {"label": "C", "text": "Hamartoma", "correct": true}, {"label": "D", "text": "Carcinoma", "correct": false}], "correct_answer": "C. Hamartoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RwzFHuAzycdtpjw5YumP1745916347.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old female patient consumed a cleaning product containing 90% sodium hydroxide. She is having complete dysphagia. What is the best step in management?", "options": [{"label": "A", "text": "Esophagojejunostomy", "correct": false}, {"label": "B", "text": "Stent placement", "correct": false}, {"label": "C", "text": "Feeding jejunostomy", "correct": true}, {"label": "D", "text": "Gastrojejunostomy", "correct": false}], "correct_answer": "C. Feeding jejunostomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alkali causes liquefaction, saponification, and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of vessels, leading to <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and stricture.</li>\n<li>Acid causes intense pylorospasm, antral pooling, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> necrosis, and <span class=\"customMeta\" data-dictid=\"6b73f3afaa1692777187f2899b6934\">eschar</span> formation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute Phase Management</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neutralization: vinegar/citrus for alkali; antacids/milk/egg whites for acid</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> to assess severity and extent</li>\n<li>Avoid emetics and sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> to prevent perforation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"13\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management by Burn Degree</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1st Degree Burns:</strong></p>\n<ul>\n<li>48 hours observation; oral feeds resumed once <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> is swallowed painlessly</li>\n<li>Regular follow-up <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> at 1st, 2nd, and 8th months to identify stricture</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"10\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2nd &amp; 3rd Degree Burns:</strong></p>\n<ul>\n<li>Fluid therapy, antibiotics, nutrition, PPIs and aerosolised steroids and resuscitation</li>\n<li>Fiberoptic-guided <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> intubation/tracheostomy, if necessary.</li>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> stenting, <strong>jejunostomy for feeding.</strong></li>\n<li>Laparoscopy for evaluation; <span class=\"customMeta\" data-dictid=\"a422b7cfac1692777191bf0a3499e4\">laparotomy</span> in unstable patients</li>\n<li>Resection and end <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"c4b16dd0101692777187f46fd03084\">esophagostomy</span> with <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is full thickness.</li>\n<li>Consider re-exploration after 36-48 hours if necessary.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> for stricture</li>\n<li>Use of various dilators (e.g., balloon, Savary-Gilliard, Eder-Puestow) for <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> dilatation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is technically difficult; <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> may be preferred</li>\n<li>Resection and end <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"c4b16dd0101692777187f46fd03084\">esophagostomy</span> with <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is full thickness</li>\n<li>A <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"2533659200169277718431206e4029\">conduit</span> may be used if the stomach is diseased</li>\n<li>Multiple strictures may require <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> transposition</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true about Congenital Hypertrophic Pyloric Stenosis?", "options": [{"label": "A", "text": "Presents with non-bilious vomiting", "correct": false}, {"label": "B", "text": "Caused by hypertrophy of longitudinal muscles", "correct": true}, {"label": "C", "text": "USG is the gold standard investigation for this condition", "correct": false}, {"label": "D", "text": "Hypokalemic metabolic alkalosis seen", "correct": false}], "correct_answer": "B. Caused by hypertrophy of longitudinal muscles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d2bZFJsSoYNpuRfm2GMG1746166879.png", "https://image.prepladder.com/content/doCciw5xVXJS6qeqp8f41746166879.png", "https://image.prepladder.com/content/NKL6uPryhD0bI4whuHYw1746166879.png", "https://image.prepladder.com/content/S9GPAOnb76uGgkimVq261746166879.png", "https://image.prepladder.com/content/nuCm9USXKsQVoSAupmLO1746166879.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Typical onset: 3 to 6 weeks of age</li>\n<li><strong>Symptoms:</strong>\n<ul>\n<li>Projectile, non-bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> <strong>(Option A ruled out)</strong></li>\n<li>Visible <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> peristalsis</li>\n<li>Palpable \"<strong>olive-like</strong>\" mass in the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> (hypertrophied pylorus), best felt from the left side\n\t\t\t\t\t<ul>\n<li><strong>Test feed:</strong> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> is seen passing from left to right across the abdomen, and in a relaxed (feeding) baby, the pyloric ‘tumor’ is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> as an ‘olive’ in the right upper quadrant.</li>\n</ul>\n</li>\n<li>Dyselectrolytemias-\n\t\t\t\t\t<ul>\n<li>Hypochloremia</li>\n<li>Hypokalemia due to persistent vomiting</li>\n<li>Metabolic alkalosis. <strong>(Option D ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"465\" src=\"https://image.prepladder.com/content/d2bZFJsSoYNpuRfm2GMG1746166879.png\" width=\"465\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound (Gold Standard)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Characteristic \"<strong>doughnut sign</strong>\" indicating thickened pyloric muscle</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Maulik S Patel\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/intussusception-transient-small-bowel#image-382247\" data-tags=\"\" height=\"463\" src=\"https://image.prepladder.com/content/doCciw5xVXJS6qeqp8f41746166879.png\" width=\"568\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Diagnostic criteria:</strong>\n<ul>\n<li>Pyloric muscle <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> ≥ 4 mm</li>\n<li>Pyloric <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> length &gt; 14 mm</li>\n<li>\"Cervix sign\" on long-axis view</li>\n<li>\"Target sign\" on short-axis view</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ahmad Ali Alomari\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/hypertrophic-pyloric-stenosis-37\" data-tags=\"\" height=\"443\" src=\"https://image.prepladder.com/content/NKL6uPryhD0bI4whuHYw1746166879.png\" width=\"443\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Meal (Less Common)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can assist in diagnosis but is less accurate than ultrasound, it reveals:</p>\n<ul>\n<li>\"String sign\": Thin streak of contrast through narrowed pylorus</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Adityagupta95, \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hypertrophic_pyloric_stenosis.png\" data-tags=\"\" height=\"407\" src=\"https://image.prepladder.com/content/S9GPAOnb76uGgkimVq261746166879.png\" width=\"320\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>\"Railroad track sign\": Two thin lines of contrast indicating mild narrowing</li>\n<li>\"Double track sign\": Similar to railroad track sign, indicating thickened muscle</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Bell D, Gaillard F, Double track sign (pyloric stenosis). Reference article, Radiopaedia.org (Accessed on 02 Jan 2025) https://doi.org/10.53347/rID-22049\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/double-track-sign-pyloric-stenosis?lang=us\" data-tags=\"\" height=\"395\" src=\"https://image.prepladder.com/content/nuCm9USXKsQVoSAupmLO1746166879.png\" width=\"593\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of anorectal fistula?", "options": [{"label": "A", "text": "Intersphincteric", "correct": true}, {"label": "B", "text": "Trans-sphincteric", "correct": false}, {"label": "C", "text": "Suprasphincteric", "correct": false}, {"label": "D", "text": "Extrasphincteric", "correct": false}], "correct_answer": "A. Intersphincteric", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uZJkGJQyRNxvbQWab1y01746167348.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Inter- sphincteric (<strong>most common</strong>, 70%) <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trans- sphincteric (25%) <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supra- sphincteric (4%) <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extra- sphincteric (1%) <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During an endoscopy, when a constriction is detected at the esophageal junction approximately 25 cm from the incisor, what is the likely cause?", "options": [{"label": "A", "text": "Inferior vena cava", "correct": false}, {"label": "B", "text": "Arch of aorta", "correct": true}, {"label": "C", "text": "Right bronchus", "correct": false}, {"label": "D", "text": "Diaphragmatic opening", "correct": false}], "correct_answer": "B. Arch of aorta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RkIw9acQ4TX3yUoqu5cx1746169889.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A homosexual man presents with painful defecation and a protruding mass from the anal canal. Biopsy confirms squamous cell carcinoma of the anus. What is the appropriate course of action for managing this patient?", "options": [{"label": "A", "text": "Chemotherapy", "correct": false}, {"label": "B", "text": "Abdominoperineal repair", "correct": false}, {"label": "C", "text": "Combined chemoradiation", "correct": true}, {"label": "D", "text": "Wide local excision", "correct": false}], "correct_answer": "C. Combined chemoradiation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> Carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"70ae0d8a1f1692777194515e8836a4\">Papillomavirus</span> (HPV) Infection: </strong>Strongly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer, particularly high-risk subtypes (16, 18, 31, 33)</li>\n<li><strong>Anal <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">Intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> (AIN): </strong>A precancerous condition significantly increases the risk of <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer, especially from AIN II or III.</li>\n<li><strong>Immunosuppression </strong>(e.g., HIV-positive, transplant recipients)</li>\n<li><strong>Sexual Practices: </strong>Anal <span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\">intercourse</span> increases <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> transmission risk.</li>\n<li><strong>History of Other <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> Neoplasia: </strong>Vulvar <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> (VIN) or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> (CIN)</li>\n<li><strong>Extensive Anogenital Condylomata: </strong>The presence of extensive anal warts <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Bleeding</li>\n<li>Palpable Mass</li>\n<li>Pruritus (Itching)</li>\n<li>Discharge</li>\n<li>Incontinence</li>\n<li>Fistulation (anterior tumour extension in women can create a <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> between the <span class=\"customMeta\" data-dictid=\"08e2e9f18c169277718155d36ba98e\">anus</span> and vagina).</li>\n<li><strong>Appearance</strong>:\n\t\t\t\t<ul>\n<li><strong>Anal margin tumours:</strong> Often resemble <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> ulcers with raised, hardened edges.</li>\n<li><strong>Anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> tumours: </strong>Typically <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> as irregular, hardened, and tender ulcerated areas.</li>\n</ul>\n</li>\n<li><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Involvement:</strong> Enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the <span class=\"customMeta\" data-dictid=\"9626003516169277719575ac559a91\">perirectal</span> or <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> regions may indicate cancer spread.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biopsy from the Anal Region: </strong>The primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test to confirm the presence of carcinoma.</li>\n<li>FNAC of Inguinal Nod (assess metastasis).</li>\n<li>USG <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">Abdomen</span> (check for any spread of the disease).</li>\n<li>MRI of the <span class=\"customMeta\" data-dictid=\"ea5dd28db71692777195ee64c2f690\">Perineum</span> (assess the extent of the tumour).</li>\n<li><strong>Proctosigmoidoscopy: </strong>Assess the upper extent of the tumour within the anal canal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chemoradiation (Nigro regimen): </strong>The preferred treatment <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> for <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> of the anal canal. <strong>(Option C)</strong>\n<ul>\n<li><strong>Chemotherapy Drugs:</strong> Commonly used drugs include 5-fluorouracil (5-FU), bleomycin, vincristine, and adriamycin.</li>\n<li><strong>Radiotherapy: </strong>Often used alone in advanced cases where the tumour is not resectable.</li>\n</ul>\n</li>\n<li><strong>Surgical Interventions:</strong>\n<ul>\n<li><strong>Abdominoperineal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> (APR) with Colostomy: </strong>For persistent or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> disease after combined <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> therapy (CMT), or for cases where the tumor does not respond to chemoradiation. <strong>(Option B ruled out)</strong></li>\n<li><strong>Neoadjuvant Chemotherapy: </strong>Involves using 5-FU, cisplatin, and <span class=\"customMeta\" data-dictid=\"2df4bdd7081692777192438ea42a62\">mitomycin</span> C before surgery to shrink the tumour.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man came with complaints of recurrent discharge and pain due to lesions around the anus for 3 years. A diagnosis of fistula-in-ano is made. What is the gold standard investigation for this condition?", "options": [{"label": "A", "text": "Fistulogram", "correct": false}, {"label": "B", "text": "USG", "correct": false}, {"label": "C", "text": "CECT", "correct": false}, {"label": "D", "text": "MRI", "correct": true}], "correct_answer": "D. MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/63lPWWY0F9Z4mjNlhhdD1746172222.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fistula-in-Ano</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A chronic <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> communication between the <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> (internal opening) and an external opening on the skin of the perineum, buttock, or, rarely, the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> in women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.</li>\n<li>Associated Conditions:\n\t\t\t\t<ul>\n<li>Crohn’s disease</li>\n<li>Tuberculosis</li>\n<li>Lymphogranuloma venereum</li>\n<li>Actinomycosis</li>\n<li>Rectal duplication</li>\n<li>Foreign bodies</li>\n<li>Malignancy (rare, can develop within a longstanding fistula)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</li>\n<li>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening, (indicative of a rectal rather than an anal internal opening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>MRI: </strong>Maps the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel and provides detailed images of the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscle and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor structures. (Investigation of choice) <strong>(Option D)</strong></li>\n<li><strong>Endoscopic Ultrasound: </strong>It uses high-frequency sound waves to identify the fistula, <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscles, and surrounding tissues.</li>\n<li><strong>Fistulography: </strong>An X-ray procedure using <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> contrast to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the anal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel. (1st investigation) <strong>(Option A ruled out)</strong></li>\n<li><strong>Examination Under Anesthesia: </strong>Allows for thorough evaluation of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel and identification of potential complications.</li>\n<li><strong>Fistula Probe: </strong>A specialized instrument is inserted through the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> to identify the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel.</li>\n<li><strong>Anoscopy: </strong>A small <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> is used to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> for assessment of fistulas during anoscopy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fistulotomy </strong></p>\n<ul>\n<li>Opening the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> to heal by secondary intention.</li>\n<li>Used for <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> and trans-sphincteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> involving &lt;30% of external sphincter; not for <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> in women.</li>\n</ul>\n<p><strong>Fistulectomy </strong></p>\n<ul>\n<li>Removal of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> using <span class=\"customMeta\" data-dictid=\"24bfc6e0cc16927771862d94b32d73\">diathermy</span> <span class=\"customMeta\" data-dictid=\"be6cf382f3169277718394516c7ca1\">cautery</span> for better <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of anatomy.</li>\n<li>Effective for understanding the fistula's <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and extensions.</li>\n</ul>\n<p><strong>Setons</strong></p>\n<ul>\n<li>Materials are inserted into the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> for <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> or gradual cutting.</li>\n<li>Loose setons promote drainage; tight/cutting setons cut through muscle over time.</li>\n</ul>\n<p><strong>Advancement Flaps</strong></p>\n<ul>\n<li>Closing the internal opening with a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> is used when the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> complex is not extensively indurated.</li>\n<li>Effective for certain <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> configurations.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Inter- sphincteric (most common, 70%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trans- sphincteric (25%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supra- sphincteric (4%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extra- sphincteric (1%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following procedures has the highest risk of causing the recurrence of duodenal ulcers?", "options": [{"label": "A", "text": "Selective Vagotomy", "correct": false}, {"label": "B", "text": "Highly selective vagotomy", "correct": true}, {"label": "C", "text": "Truncal vagotomy", "correct": false}, {"label": "D", "text": "Truncal Vagotomy with Antrectomy", "correct": false}], "correct_answer": "B. Highly selective vagotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/irgza2k1YNZU95GwK7V01747400967.png", "https://image.prepladder.com/notes/mnfPlfL9rZ6oUOA5FQGi1747401080.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Truncal Vagotomy</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Truncal <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">Vagotomy</span> with Antrectomy</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Selective Vagotomy</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Highly Selective Vagotomy</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Nerves Divided</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Left and right <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> above <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> and <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Truncal <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">vagotomy</span> plus removal of the antrum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Main right and left <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Only nerves to the acid-producing portion (all branches to the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> and body) of the stomach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Drainage Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Usually required</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Required</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Not required</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Acid Reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>~50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>~85%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>&lt;50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Variable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Ulcer Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>2-7%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>5-10%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>2-10%%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Significant side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>&lt;5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman underwent surgical resection of her bowel; after a few months, she presents with easy fatigability and tiredness. Blood smear evaluation shows macrocytic anaemia. Resection of all of the following can cause this, except:", "options": [{"label": "A", "text": "Jejunum", "correct": false}, {"label": "B", "text": "Duodenum", "correct": true}, {"label": "C", "text": "Ileum", "correct": false}, {"label": "D", "text": "Stomach", "correct": false}], "correct_answer": "B. Duodenum", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vw93lEsotekm0WVczVrd1745336557.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Folic acid Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin B12 Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Site of <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> - <span class=\"customMeta\" data-dictid=\"4b145c8d1b1692777190177246177d\">Jejunum</span> <strong>(Option A ruled out)</strong></li>\n<li>Seen in: Alcoholics, pregnancy</li>\n<li>Causes <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects</li>\n<li>Neurological symptoms are not seen</li>\n<li>Normal methylmalonic acid</li>\n<li>High homocysteine</li>\n<li>FIGLU test positive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Site of B12 <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> - <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">Ileum</span> <strong>(Option C ruled out)</strong></li>\n<li>Seen in: Vegetarians, pregnancy, <span class=\"customMeta\" data-dictid=\"8559a65a1116927771864c296ce496\">Diphyllobothrium</span> latum infection</li>\n<li>Neurological manifestation: <span class=\"customMeta\" data-dictid=\"159e1426d61692777199d9361738d0\">Subacute</span> combined degeneration</li>\n<li>High methylmalonic acid</li>\n<li>High homocysteine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:518px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part of the Small Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nutrient absorbed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duodenum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iron</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jejunum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Folic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ileum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin B12</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding acute cholecystitis is false?", "options": [{"label": "A", "text": "Gall bladder thickness &amp;gt;3 mm on USG", "correct": false}, {"label": "B", "text": "Murphy’s sign positive", "correct": false}, {"label": "C", "text": "Leukocytosis", "correct": false}, {"label": "D", "text": "Gold standard investigation is CT scan", "correct": true}], "correct_answer": "D. Gold standard investigation is CT scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/oEUbofabxizTpQbTx3oK1745336556.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tokyo Guidelines for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">Cholecystitis</span> (2013/2018)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local Signs of Inflammation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Murphy's sign <strong>(Option B ruled out)</strong></li>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RUQ) pain/ <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> or a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Signs of Inflammation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Elevated CRP</li>\n<li>Elevated WBC <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Findings:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gallbladder wall thickening (&gt;3 mm) <strong>(Option A ruled out)</strong></li>\n<li>Pericholecystic fluid,</li>\n<li>Ultrasonographic Murphy's sign.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a perineal approach for the condition shown in the image?", "options": [{"label": "A", "text": "Rip stein's procedure", "correct": true}, {"label": "B", "text": "Delorme’s operation", "correct": false}, {"label": "C", "text": "Thiersch operation", "correct": false}, {"label": "D", "text": "Altemeier’s procedure", "correct": false}], "correct_answer": "A. Rip stein's procedure", "question_images": ["https://image.prepladder.com/notes/fxYHPaEsctFtXU1V6k9K1746704704.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:729px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h5><strong>Aspect</strong></h5>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h5><strong>Abdominal Rectopexy</strong></h5>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h5><strong>Perineal Rectopexy</strong></h5>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic or <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> rectopexy-anterior/ posterior- <strong>Well's, Ripstein </strong><strong>(Option A)</strong></li>\n<li>Suture rectopexy- <strong>Lahaut</strong></li>\n<li>Anterior Resection</li>\n<li>Resection Rectopexy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal sleeve <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (<strong>Delrome's</strong>) <strong>(Option B ruled out)</strong></li>\n<li>Perineal recto <span class=\"customMeta\" data-dictid=\"c571bd042816927771984a81e88895\">sigmoidectomy</span> (<strong>Altemeier's</strong>) <strong>(Option D ruled out)</strong></li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> of <strong>Lockhardt-Mummery </strong></li>\n<li><strong>Mickulicz Miles</strong> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> <span class=\"customMeta\" data-dictid=\"ebf9c40d2b16927772009a937efb25\">transanal</span> recto sigmoidectomy</li>\n<li>Anal encircling (<strong>Thiersch</strong>) <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fixation of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> provides adequate tension to prevent recurrence.</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> options (laparoscopic or robotic) offer benefits in pain control, hospital stay, and recovery time</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lower <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality, suitable for elderly or medically unfit patients.</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires extensive <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> and fixation, which may have higher <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> (10%-33%).</li>\n<li>Risk of mesh-related complications such as erosion, infection, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, and migration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approaches</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal</li>\n<li>There is no <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer.</li>\n<li>It is the most common type of rectal prolapse.</li>\n<li>History of mass per anum.</li>\n<li>Pink in colour and circumferential.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete-full thickness.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> contains all layers of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> (i.e. including the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer).</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> as mass <span class=\"customMeta\" data-dictid=\"be836a0f5e169277719538e60bc715\">per anum</span> circumferentially, which is red in colour. Mass is usually <span class=\"customMeta\" data-dictid=\"7b497fabf51692777197384bc1248f\">reducible</span> and painless.</li>\n<li>It may be associated with <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> (uterine procidentia) in females.</li>\n<li>Fecal <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (75%) is very common.</li>\n<li>Bleeding can occur because of the congestion.</li>\n<li>Sepsis, discharge, fever, and anaemia are other features.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who had grade 3 splenic trauma was managed conservatively in the ICU. Which of the following signs on day 2 would indicate a need for surgery?", "options": [{"label": "A", "text": "Hemoglobin falls from 12 mg/dL to 10 mg/dL", "correct": false}, {"label": "B", "text": "Extraperitoneal bladder rupture", "correct": false}, {"label": "C", "text": "Pneumoperitoneum", "correct": true}, {"label": "D", "text": "Air in gallbladder", "correct": false}], "correct_answer": "C. Pneumoperitoneum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-surgical Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine and Metabolic</strong></p>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> porphyria</li>\n<li>Addisonian crisis</li>\n<li>Diabetic crisis</li>\n<li>Hereditary Mediterranean fever</li>\n<li>Uremia</li>\n</ul>\n<p><strong>Hematologic </strong></p>\n<ul>\n<li>Acute leukemia</li>\n<li>Sickle cell crisis</li>\n</ul>\n<p><strong>Toxins and drugs</strong></p>\n<ul>\n<li>Black widow <span class=\"customMeta\" data-dictid=\"87bbbfb59516927771992f5372ca87\">spider</span> poisoning</li>\n<li>Lead poisoning</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"6e8ada09fa1692777189bfbace851a\">heavy metal</span> poisoning</li>\n<li>Narcotic withdrawal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemorrhage </strong></p>\n<ul>\n<li>Aortoduodenal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> after aortic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> graft</li>\n<li>Arteriovenous <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> of the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract</li>\n<li>Bleeding <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> diverticulum</li>\n<li>Hemorrhagic pancreatitis</li>\n<li>Intestinal ulceration</li>\n<li>Leaking or ruptured arterial aneurysm</li>\n<li>Mallory-Weiss syndrome</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy</li>\n<li>Solid organ trauma</li>\n<li>Spontaneous splenic rupture</li>\n</ul>\n<p><strong>Infections </strong></p>\n<ul>\n<li>Appendicitis</li>\n<li>Cholecystitis</li>\n<li>Diverticulitis</li>\n<li>Hepatic abscess</li>\n<li>Meckel diverticulitis</li>\n<li>Psoas abscess</li>\n</ul>\n<p><strong>Ischemia </strong></p>\n<ul>\n<li>Buerger’s disease</li>\n<li>Ischemic colitis</li>\n<li>Mesenteric <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> or embolism</li>\n<li>Ovarian torsion</li>\n<li>Strangulated hernia</li>\n<li>Testicular torsion</li>\n</ul>\n<p><strong>Obstruction </strong></p>\n<ul>\n<li>Cecal volvulus</li>\n<li>Gastrointestinal malignancy</li>\n<li>Incarcerated hernias</li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</li>\n<li>Intussusception</li>\n<li>Sigmoid volvulus</li>\n<li>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction</li>\n</ul>\n<p><strong>Perforation</strong></p>\n<ul>\n<li>Boerhaave syndrome</li>\n<li>Perforated diverticulum</li>\n<li>Perforated <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> cancer</li>\n<li>Perforated <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> ulcer</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>American Association for the Surgery of Trauma - AAST <span class=\"customMeta\" data-dictid=\"6a4861c8d71692777199aeb1d55c85\">Spleen</span> Injury scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I (Minor Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> affects less than 10% of the splenic surface area.</li>\n<li>Capsular tear that is less than 1 cm in depth without active bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-50% of the splenic surface area.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> less than 5 cm in diameter.</li>\n<li>Laceration between 1 and 3 cm in depth that doesn't involve trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covering more than 50% of the splenic surface area or expanding hematoma.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> greater than 5 cm or expanding.</li>\n<li>Laceration is more than 3 cm in depth or involves trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laceration affects <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> or hilar vessels, with evidence of devascularisation involving more than 25% of the spleen.</li>\n<li>Injury to the splenic <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> that results in major blood loss.</li>\n<li>Any injury in the presence of splenic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury or active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> within the splenic capsule</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade V (Severe Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Completely shattered spleen.</li>\n<li>Vascular injury involving the splenic <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> that results in complete devascularisation of the spleen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient was diagnosed with gastric cancer. On immunohistopathology, the biopsy sample was positive for CD117 and negative for LCA, cytokeratin, and S100. What is the diagnosis? LCA - Leucocyte common antigen GIST - Gastrointestinal stromal tumors SCC - Squamous cell carcinoma", "options": [{"label": "A", "text": "GIST", "correct": true}, {"label": "B", "text": "Adenocarcinoma", "correct": false}, {"label": "C", "text": "Hodgkin’s lymphoma", "correct": false}, {"label": "D", "text": "SCC", "correct": false}], "correct_answer": "A. GIST", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Expression in GISTs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Old Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD117 (c-KIT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Expressed in approximately 97% of GISTs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crucial for diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD34</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Expressed in 70% GISTs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> progenitor cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SMA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Some GISTs show positivity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common compared to CD117 and CD34</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>New Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PDGFRA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutations found in approximately 5-10% of GISTs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> marker</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DOG1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Expressed in many GISTs, including those negative for CD117</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternative <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:289px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very low risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-5cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-10cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10cm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient is planned for cholecystectomy. Which of the following is not an advantage of laparoscopic surgery?", "options": [{"label": "A", "text": "Lesser post-operative pain", "correct": false}, {"label": "B", "text": "Cosmetically better", "correct": false}, {"label": "C", "text": "Earlier return to normal physiological function", "correct": false}, {"label": "D", "text": "Longer duration of stay in hospital", "correct": true}], "correct_answer": "D. Longer duration of stay in hospital", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Severe, intractable pain in advanced rectum cancers is due to:", "options": [{"label": "A", "text": "Anterior infiltration in prostate", "correct": false}, {"label": "B", "text": "Anterior infiltration in the bladder", "correct": false}, {"label": "C", "text": "Posterior infiltration in sacral plexus", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:574px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Local Excision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suitable for early-stage cancers (T1 and selected T2) with good <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> factors; preserves <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and anal sphincter, minimizing <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function impact.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Anterior Resection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred for most cancers in the middle and lower rectum; involves removing affected rectal parts and reconnecting the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> to the remaining rectum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Abdominoperineal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> (APR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reserved for <strong>low-lying, extensive tumours</strong> unsuitable for sphincter-saving; involves removing rectum, anus, and surrounding tissues, creating a permanent colostomy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hartmann's Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves removing the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and creating a temporary colostomy, suitable for elderly or frail patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which investigation is not necessary for the following condition?", "options": [{"label": "A", "text": "Timed barium study", "correct": false}, {"label": "B", "text": "Endoscopy", "correct": false}, {"label": "C", "text": "Esophageal manometry", "correct": false}, {"label": "D", "text": "24-hour pH monitoring", "correct": true}], "correct_answer": "D. 24-hour pH monitoring", "question_images": ["https://image.prepladder.com/notes/FhoodtCtRfe1epkr1EqL1745297214.png"], "explanation_images": ["https://image.prepladder.com/notes/Q6o0WDD3EnqegCAu0bdb1745297581.png", "https://image.prepladder.com/notes/RTvxmUM9XSz3LYrDKMSv1745297640.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Achalasia Cardia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the oesophagal wall. This leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and failure of the lower oesophagal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal Manometry </strong><strong>(Option C ruled out)</strong></p>\n<ul>\n<li><strong>Gold Standard:</strong> This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the oesophagus.</li>\n<li>Elevated resting <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n<p><strong>Barium Swallow (Esophagram) </strong><strong>(Option A ruled out)</strong></p>\n<ul>\n<li>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> (Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA325\" data-author=\"Mohammad Niknejad\" data-hash=\"10834\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/achalasia-rat-tail-sign#image-57346336\" data-tags=\"April2025\" height=\"242\" src=\"https://image.prepladder.com/notes/Q6o0WDD3EnqegCAu0bdb1745297581.png\" width=\"132\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Endoscopy </strong><strong>(Option B ruled out)</strong></p>\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris; it is important to rule out other causes of dysphagia, such as tumours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological Treatments</strong></p>\n<ul>\n<li>Calcium Channel Blockers (reduce <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure)</li>\n<li>Nitrates (relax the LES)</li>\n<li>5'-Phosphodiesterase Inhibitors (increase <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> GMP to lower <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> pressure)</li>\n<li>Botulinum Toxin (Botox) Injections (temporarily paralyse <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscles).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Surgical Interventions</strong></p>\n<ul>\n<li>Bougie/Balloon Dilatation (ruptures <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscle fibres to reduce pressure).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatments</strong></p>\n<ul>\n<li><strong>Laparoscopic Heller's Cardiomyotomy</strong> (Most common)\n\n\t\t\t\t<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> in the <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscle to reduce pressure.</li>\n<li>It is often combined with a fundoplication.</li>\n</ul>\n</li>\n<li><strong>Partial Fundoplication</strong>\n<ul>\n<li>Prevents reflux; options include Dor or Toupet fundoplication.</li>\n</ul>\n</li>\n<li><strong>Esophagectomy</strong>\n<ul>\n<li>Surgical removal of the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> (severe cases).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Treatments</strong></p>\n<ul>\n<li><strong>Per-Oral Endoscopic <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">Myotomy</span> (POEM): </strong>A newer Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedure involving <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> of <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> muscle fibres.<strong> </strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"SU829\" data-author=\"NA\" data-hash=\"10836\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"400\" src=\"https://image.prepladder.com/notes/RTvxmUM9XSz3LYrDKMSv1745297640.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following causes maximum malnutrition?", "options": [{"label": "A", "text": "Pancreatic fistula", "correct": false}, {"label": "B", "text": "Duodenal fistula", "correct": true}, {"label": "C", "text": "Distal ileal fistula", "correct": false}, {"label": "D", "text": "Colonic fistula", "correct": false}], "correct_answer": "B. Duodenal fistula", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2X5B6Ug6gzxjbiLYwJbS1746702586.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerves would be involved if a patient experiences a loss of sensations over the root of the penis after undergoing open hernia surgery?", "options": [{"label": "A", "text": "Iliohypogastric nerve", "correct": false}, {"label": "B", "text": "Ilioinguinal nerve", "correct": true}, {"label": "C", "text": "Genitofemoral nerve", "correct": false}, {"label": "D", "text": "Medial cutaneous nerve to thigh", "correct": false}], "correct_answer": "B. Ilioinguinal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/kQogKGjpfBmA2FCDMCJO1745298238.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child with hereditary spherocytosis and hypersplenism presents to the hospital. A splenectomy is planned for this child. All the following vaccines are recommended before splenectomy except?", "options": [{"label": "A", "text": "Pneumococcal vaccine", "correct": false}, {"label": "B", "text": "Typhoid vaccine", "correct": true}, {"label": "C", "text": "Haemophilus influenza B vaccine", "correct": false}, {"label": "D", "text": "Meningococcal vaccine", "correct": false}], "correct_answer": "B. Typhoid vaccine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:698px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults (age 19 and older)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumococcal </strong><strong>(Option A ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PCV13 followed by PVC13 8 weeks later.</li>\n<li>PPSV23 8 weeks later.</li>\n<li>Repeat PPSV23 at 5 years</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PCV13 followed by PPSV23 8 weeks later</li>\n<li>Repeat PPSV23 every 5 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningococcal </strong><strong>(Option D ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MenACWY series AND MenB series</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MenACWY or MPSV4 2 months apart</li>\n<li>Repeat MenACWY every 5 years AND MenB series once.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><em>Haemophilus influenzae</em></strong><strong> <span class=\"customMeta\" data-dictid=\"0dddac147b1692777201460ab59600\">type B</span> </strong><strong>(Option C ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hib once if 15 months or older and previously not vaccinated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hib once</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Always indicated in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Usually indicated in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low benefit</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Grade V splenic injury</li>\n<li>Primary splenic tumor</li>\n<li>Hereditary spherocytosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic ITP</li>\n<li>Abscess<strong> </strong><strong> </strong></li>\n<li>Splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> leading to <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> varices</li>\n<li>Primary hypersplenism</li>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (AIHA)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thalassaemia</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"258737f45016927771931e053a03d1\">myelogenous</span> <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> (CML)</li>\n<li>Gaucher's disease</li>\n<li>Hodgkin's <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> laparotomy</li>\n<li>Sickle cell anemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about psoas abscess are true? Fluctuant swelling in the hip Cold abscess can develop from Pott’s abscess Pain on the passive extension of the hip joint is seen It develops more commonly through the hematogenous route in immunocompromised patients and elderly.", "options": [{"label": "A", "text": "1 and 2", "correct": false}, {"label": "B", "text": "1, 3 and 4", "correct": false}, {"label": "C", "text": "1, 2, 3 and 4", "correct": true}, {"label": "D", "text": "2, 3 and 4", "correct": false}], "correct_answer": "C. 1, 2, 3 and 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/6NACmEtJ1wciTvzXFP7b1745298900.png", "https://image.prepladder.com/notes/VkOeGpxbRQGxiInlCe901746703316.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following would be the most commonly encountered ectopic tissue in Meckel’s diverticulum?", "options": [{"label": "A", "text": "Gastric and pancreatic", "correct": true}, {"label": "B", "text": "Colonic and pancreatic", "correct": false}, {"label": "C", "text": "Gastric and colonic", "correct": false}, {"label": "D", "text": "Thyroid and lung", "correct": false}], "correct_answer": "A. Gastric and pancreatic", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/zknCFFtZ1mMFOnequ9ry1745301057.png", "https://image.prepladder.com/notes/LTxLhsbq8qervkMKY6wi1745301017.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meckel's Diverticulum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> in Meckel’s <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> is <strong>Gastric &gt; Pancreatic &gt; Colonic </strong><strong>(Option A) </strong><strong>(Option B, C ruled out)</strong></li>\n<li>The most common symptom in children is <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding.</li>\n<li>Ulcers are formed in the surrounding area due to acid secreted from the <strong>ectopic <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> in Meckel’s diverticulum</strong>, which causes bleeding.</li>\n<li>The most common symptom in adults is <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n<li>Complications: Volvulus, intestinal obstruction, intussusceptions, <span class=\"customMeta\" data-dictid=\"c8de4db86c16927771862eeef04df3\">diverticulitis</span> and perforation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>99mTc-pertechnetate scan: </strong>Absorbed by the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa, allowing for visualisation.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Meckel Diverticulum Investigation\" data-author=\"Weerakkody Y, Walizai T, Sharma R\" data-hash=\"10861\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/meckel-diverticulum-3\" data-tags=\"April2025\" height=\"300\" src=\"https://image.prepladder.com/notes/LTxLhsbq8qervkMKY6wi1745301017.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Plain <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> radiography, CT abdomen, and <span class=\"customMeta\" data-dictid=\"b93d06140916927772017ebc71db88\">ultrasonography</span> are seldom useful.</li>\n<li>Endoscopy:<strong> </strong>Helpful in <span class=\"customMeta\" data-dictid=\"1cea73363016927772026799cd008c\">false-negative</span> cases, but not the investigation of choice.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Healthy base (no <span class=\"customMeta\" data-dictid=\"7a14c26a7816927771904fb670c6da\">induration</span> or ulceration)</strong>: Diverculectomy (excision of the <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> only) + anastomosis.</li>\n<li><strong>Unhealthy base (ulceration, presence of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa)</strong>: Resection of the small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> with the <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> + anastomosis.<strong> </strong></li>\n<li><strong>Incidentally detected</strong> during an <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> surgery: Diverculectomy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is true about gall bladder carcinoma?", "options": [{"label": "A", "text": "Palpable abdominal lump is the earliest sign", "correct": false}, {"label": "B", "text": "Earliest sign is jaundice", "correct": false}, {"label": "C", "text": "Gallstones and gallbladder cancer are easily distinguished clinically", "correct": false}, {"label": "D", "text": "Median survival is less than 6 months", "correct": true}], "correct_answer": "D. Median survival is less than 6 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gallbladder Cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gallstones</strong></li>\n</ul>\n<ul>\n<li>Choledochal cyst</li>\n<li>Anomalous <span class=\"customMeta\" data-dictid=\"c2ae5e9c971692777194234dc59b3b\">pancreaticobiliary</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> junction</li>\n<li>Cholesterosis of the gallbladder</li>\n<li>Gallbladder polyps</li>\n<li>Porcelain gallbladder</li>\n<li>Infections and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions\n\t\t\t\t<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"f2f6f9068216927772016cacf26183\">typhoid</span> carriers</li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</li>\n<li>Hepatitis B and <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> C virus infections</li>\n</ul>\n</li>\n<li>Other factors:\n\t\t\t\t<ul>\n<li>Polypoid lesions (GB polyp)</li>\n<li>Xanthogranulomatous cholecystitis</li>\n<li>Nitrosamines</li>\n<li>Carcinogens</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often indistinguishable from <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> diseases <strong>(Option C ruled out) </strong></li>\n<li><strong>Symptoms include:</strong>\n<ul>\n<li>Biliary colic</li>\n<li>Cholecystitis (especially in older individuals)</li>\n<li>Jaundice (late-stage) <strong>(Option B ruled out) </strong></li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> (late-stage)</li>\n<li>Palpable mass (late-stage) <strong>(Option A ruled out) </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Non-specific indicators:</strong>\n<ul>\n<li>Anemia</li>\n<li>Leukocytosis</li>\n<li>Slight increase in transaminases</li>\n</ul>\n</li>\n<li><strong>Tumor markers:</strong>\n<ul>\n<li>Elevated CA19-9</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"11b3cfa9a31692777183e48dccbc39\">carcinoembryonic</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (in ~80% of patients)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography (USG): </strong>Initial diagnosis</li>\n<li><strong>CT Scans:</strong> Thorax, abdomen, and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> for confirmation and staging</li>\n<li><strong>MRI/MRCP:</strong> For accurate <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> staging</li>\n<li><strong>PET Scans:</strong> To identify metastatic disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging and Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Preoperative Staging: </strong>Crucial to assess local disease extent and rule out distant metastases</li>\n<li><strong>Percutaneous Biopsy:</strong> Guided by radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for unresectable tumours</li>\n<li><strong>Laparoscopic Examination: </strong>Detects peritoneal or liver <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> that preclude surgery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early disease: </strong>\n<ul>\n<li>For disease confined to the mucosa, if there is negative <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> margin and no <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> on imaging- No further treatment</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>For <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> disease- Radical <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> fossa, liver wedge, and regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</li>\n</ul>\n<ul>\n<li><strong>Advanced Cancer:</strong>\n<ul>\n<li>Non-operative <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> care.</li>\n<li>Endoscopic/percutaneous methods to relieve obstructive jaundice.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Adenocarcinoma:</strong>\n<ul>\n<li>Early-stage limited to mucosa:</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>No additional treatment is required if <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> shows no recurrence.</li>\n</ul>\n<ul>\n<li>Beyond mucosa:\n\t\t\t\t<ul>\n<li>Extensive surgery involving <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> fossa, a portion of the liver, and nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who had undergone appendectomy 2 days ago presents with severe abdominal pain. On exploration, there is a collection of blood in the abdomen. Which of the following arteries should have been ligated during surgery?", "options": [{"label": "A", "text": "Ileocolic artery", "correct": true}, {"label": "B", "text": "Right colic artery", "correct": false}, {"label": "C", "text": "Superior rectal artery", "correct": false}, {"label": "D", "text": "Superior mesenteric artery", "correct": false}], "correct_answer": "A. Ileocolic artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/WuCKhKMSqjYeOe9Nb1Kl1745301536.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent step in managing a 32-year-old male patient who comes to the surgical emergency department with a 2-day history of peptic ulcer disease, experiencing abdominal pain, bloating, and difficulty passing stools? IV fluids CECT abdomen Exploratory laparotomy Upper GI endoscopy Below is the provided X-ray film image", "options": [{"label": "A", "text": "A and B", "correct": false}, {"label": "B", "text": "A and C", "correct": true}, {"label": "C", "text": "A and D", "correct": false}, {"label": "D", "text": "A, B and C", "correct": false}], "correct_answer": "B. A and C", "question_images": ["https://image.prepladder.com/notes/qD4AldYw6PvUaSz89qxJ1745304320.png"], "explanation_images": ["https://image.prepladder.com/notes/Kz3QEHHDFAt9RSdfNQsp1745304371.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> perforation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> duodenal ulcers.</li>\n<li>Presents with an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> with sudden-onset, severe epigastric pain, <span class=\"customMeta\" data-dictid=\"a4812dcf9b169277719756aaf48b7c\">rebound</span> tenderness, and air under the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> in the radiograph. <strong>(Option B)</strong></li>\n<li><strong>Management: </strong>\n<ul>\n<li><strong>Non-surgical: </strong>\n<ul>\n<li>Nil per-oral</li>\n<li>IV antibiotics and PPIs</li>\n</ul>\n</li>\n<li><strong>Surgical: </strong>\n<ul>\n<li>Initial <span class=\"customMeta\" data-dictid=\"95c41bced21692777187fa909c1937\">empirical</span> <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> treatment.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> is approached by a small upper midline incision</li>\n<li>Perforations &lt;1cm are closed primarily and buttressed with a well-vascularized omentum</li>\n<li>Larger perforations &amp; with fibrotic edges: Modified Graham's Repair or Omental Patch Repair.</li>\n<li>The vascularized <span class=\"customMeta\" data-dictid=\"af0f51214e16927771952526edf6bc\">pedicle</span> of the <span class=\"customMeta\" data-dictid=\"5ff2b859c11692777188cefd34c13b\">greater omentum</span> is patched over the defect.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Omental patch repair\" data-author=\"NA\" data-hash=\"10871\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"329\" src=\"https://image.prepladder.com/notes/Kz3QEHHDFAt9RSdfNQsp1745304371.png\" width=\"437\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding duodenal ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> is the one that usually bleeds.</li>\n<li>It is due to the involvement of the <span class=\"customMeta\" data-dictid=\"5f1eca7eaa1692777188e4f8827ef9\">gastroduodenal</span> artery.</li>\n<li>This leads to hematemesis, <span class=\"customMeta\" data-dictid=\"cdfd662dbf1692777192da96520d89\">melena</span> or both i.e., an upper GI bleed.</li>\n<li>Bleeding is commonly associated with <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> of NSAIDs.</li>\n<li><strong>Management: </strong>\n<ul>\n<li>Endoscopic: Done to find the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> source and manage bleeds endoscopically. Injection, <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> coagulation, <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"06a6e8bfbb169277718202d47f2d42\">argon</span> coagulation, mechanical clips, and <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> <span class=\"customMeta\" data-dictid=\"ffd65f286616927771883be907f80a\">glue</span> are the methods used. (with or without <span class=\"customMeta\" data-dictid=\"35b6a8aeb416927771805fcc2e7dfb\">adrenaline</span> injection).</li>\n<li>Angiographic management: If <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> management fails.</li>\n<li>Surgical management:\n\t\t\t\t\t<ul>\n<li>Exposure to the <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> and <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> are the principles here.</li>\n<li>Duodenotomy</li>\n<li>Ligation of the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> vessel with <span class=\"customMeta\" data-dictid=\"41621596221692777200ad9bb50bc5\">truncal</span> <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">vagotomy</span> with pyloroplasty</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric Outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (GOO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> or <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> leads to mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with a functional <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> outlet obstruction.</li>\n<li>Presents with nausea, early satiety, vomiting, loss of weight, and anorexia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hourglass deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is seen in chronic <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> ulcers with <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyloric stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is seen in cases of chronic ulcers, which lead to <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> and <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> of the pylorus.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the correct statement regarding gastric carcinoma: It is mostly hereditary E-cadherin adhesion defect is seen in diffuse types of gastric CA. Wnt signaling pathway defect is seen in intestinal-type gastric CA. Depth of cancer has no role in prognosis.", "options": [{"label": "A", "text": "A, C, D", "correct": false}, {"label": "B", "text": "B, C", "correct": true}, {"label": "C", "text": "B, C, D", "correct": false}, {"label": "D", "text": "A, D", "correct": false}], "correct_answer": "B. B, C", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-salt foods (e.g., salted and smoked meats), low <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> of fruits and vegetables<strong> </strong></p>\n<p>N-nitroso compounds are formed from nitrates in high-salt and smoked foods, Similar to tobacco smoke</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle habits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking, alcohol, poor food preparation (smoked, salted), lack of refrigeration, contaminated drinking water, low socioeconomic status</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infectious Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>H- pylori infection: </strong>M/c <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> cause of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer.</p>\n<p><strong>Mechanism</strong>: <span class=\"customMeta\" data-dictid=\"e025d338b21692777184b4a309cbfb\">Chronic inflammation</span> leading to atrophic gastritis, intestinal metaplasia, dysplasia, and carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polyps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenomatous polyps (risk of malignancy)</li>\n<li>In multiple polyps, the largest one is excised, and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> from others is taken.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>E-cadherin (CDH1) gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (hereditary <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer) <strong>(Statement B)</strong></li>\n<li>Hereditary cancer syndromes</li>\n<li><strong>Li- Fraumeni syndrome</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proton pump inhibitors</strong> (long-term use creates low-acid environment achlorhydria; Risk for H. pylori colonisation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastric ulcers, <span class=\"customMeta\" data-dictid=\"5cc1ea37091692777195fbd0aa687b\">pernicious</span> anaemia (achlorhydria), obesity, Epstein-Barr virus, prior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"35bafad73816927771904e162f4a70\">irradiation</span> (for testicular cancer or Hodgkin’s lymphoma), prior <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> surgery, male sex</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with large intra-abdominal fluid accumulation and was found to have pancreatic necrosis. Which of the following are included in the management of the condition? Antibiotics IV IV fluids Culture MRI Assisted drainage Laparotomy", "options": [{"label": "A", "text": "1, 2, 3, 4 and 5", "correct": false}, {"label": "B", "text": "2, 4, 5 and 6", "correct": false}, {"label": "C", "text": "1, 2, 3, 5 and 6", "correct": true}, {"label": "D", "text": "1, 2, 3, 4, 5 and 6", "correct": false}], "correct_answer": "C. 1, 2, 3, 5 and 6", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most prevalent condition that leads to the occurrence of heartburn and chest pain in a patient?", "options": [{"label": "A", "text": "Barrett's esophagus", "correct": false}, {"label": "B", "text": "Pneumonia", "correct": false}, {"label": "C", "text": "Myocardial infarction", "correct": false}, {"label": "D", "text": "Esophagitis", "correct": true}], "correct_answer": "D. Esophagitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) Esophag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby playing unsupervised was brought with complaints of difficulty in swallowing for the last few hours. The x-ray image is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Foreign body in the trachea", "correct": false}, {"label": "B", "text": "Foreign body in the esophagus", "correct": true}, {"label": "C", "text": "Foreign body in lungs", "correct": false}, {"label": "D", "text": "Foreign body in pleura", "correct": false}], "correct_answer": "B. Foreign body in the esophagus", "question_images": ["https://image.prepladder.com/content/KZi79NlPwQc8hfEjwPNe1745919811.png"], "explanation_images": [], "explanation": "<p>Correct answer B) Foreign body in the esophagu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate next course of action in managing a male patient, aged 40, who presents with widespread abdominal pain and has a confirmed history of Crohn's disease, as well as rigidity and guarding observed during a physical examination, with ileal perforation being detected on imaging?", "options": [{"label": "A", "text": "Antibiotics and NPO", "correct": false}, {"label": "B", "text": "Upper GI endoscopy", "correct": false}, {"label": "C", "text": "Urgent surgical exploration with ileostomy", "correct": true}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "C. Urgent surgical exploration with ileostomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Urgent &lt;span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\"&gt;surgical&lt;/span&gt; exploration with\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male presented with a painless mass in the right inguinal region. On examination, there is a cough impulse on the index finger. The swelling reaches the scrotum and is reduced completely by pressing it through the deep inguinal ring with a gurgling sound. What is the likely diagnosis?", "options": [{"label": "A", "text": "Femoral hernia", "correct": false}, {"label": "B", "text": "Direct inguinal hernia", "correct": false}, {"label": "C", "text": "Indirect inguinal hernia", "correct": true}, {"label": "D", "text": "Umbilical hernia", "correct": false}], "correct_answer": "C. Indirect inguinal hernia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 40-year-old patient who has experienced the passage of mucus and blood in their stool, with inflammation predominantly observed in the rectum during sigmoidoscopy, and the presence of crypt abscess detected during biopsy?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": true}, {"label": "B", "text": "Irritable bowel syndrome", "correct": false}, {"label": "C", "text": "Crohn disease", "correct": false}, {"label": "D", "text": "Pseudomembranous colitis", "correct": false}], "correct_answer": "A. Ulcerative colitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tWTP1ZKXyxSdhXeA15HT1745925321.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crohn’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited to <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can involve any part of the GI tract</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patchy, with skip lesions.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gross appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> and granularity</li>\n<li>Broad-based ulcers with a continuous pattern</li>\n<li>Pseudopolyps</li>\n<li>Mucosal atrophy</li>\n<li>Smooth, continuous inflammation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transmural inflammation</li>\n<li>Aphthous ulcers</li>\n<li><strong>Cobblestone appearance</strong></li>\n<li>Fistulae, strictures, abscesses</li>\n<li>Creeping fat (mesenteric fat wrapping)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Toxic megacolon</li>\n<li>Colonic dilation</li>\n<li>Mucosal bridges</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Strictures</strong></li>\n<li><strong>Fistulae</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly male patient presented with purulent discharge from an opening located in the perianal region. The patient is put in a lithotomy position, and the opening is located at the 11 o’clock position, 2 cm from the anal margin. What will be the likely position of the internal opening, and where does the internal opening start?", "options": [{"label": "A", "text": "12 o’clock and at the external anal sphincter", "correct": false}, {"label": "B", "text": "11 o’clock and at the internal anal sphincter", "correct": true}, {"label": "C", "text": "9 o’clock and at anal verge", "correct": false}, {"label": "D", "text": "6 o’clock and crypt of the dentate line", "correct": false}], "correct_answer": "B. 11 o’clock and at the internal anal sphincter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LdwQN8OF16lZ726w3TWI1745929260.png"], "explanation": "<p>Correct answer B) 11 o’clock and at the internal anal sph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable outcome for the patient after undergoing gastrectomy?", "options": [{"label": "A", "text": "Folic acid deficiency", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "C", "text": "Gastric ulcer", "correct": false}, {"label": "D", "text": "Constipation", "correct": false}], "correct_answer": "B. Vitamin B12 deficiency", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a patient who exhibits symptoms of dysphagia, experiencing pain behind the breastbone, and regurgitation accompanied by coughing following meals?", "options": [{"label": "A", "text": "Brown Patterson Kelly syndrome", "correct": false}, {"label": "B", "text": "Achalasia", "correct": false}, {"label": "C", "text": "Esophageal diverticula", "correct": true}, {"label": "D", "text": "Reflux esophagitis", "correct": false}], "correct_answer": "C. Esophageal diverticula", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;Esophageal&lt;/span&gt; diverticula</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zenker’s Diverticulum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> (pharyngoesophageal junction)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cricopharyngeal muscle <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (pulsion)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysphagia, regurgitation, halitosis, aspiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Barium swallow (posterior outpouching)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diverticulectomy or <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> myotomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mid-Esophageal Diverticulum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-esophagus (middle third)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traction from <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (e.g., TB)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually, <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or mild dysphagia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Barium swallow (mid-esophageal outpouching)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment unless symptomatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epiphrenic Diverticulum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> (above LES)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Esophageal <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> disorders (e.g., achalasia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysphagia, regurgitation, <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> cough</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Barium swallow (outpouching near LES)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">myotomy</span> or diverticulectomy, if needed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with ascites visiting your clinic for diagnostic paracentesis, you opt for a midline approach to remove the fluid. Which of the following size needles is used during this procedure?", "options": [{"label": "A", "text": "14 gauge", "correct": false}, {"label": "B", "text": "16 gauge", "correct": false}, {"label": "C", "text": "17 gauge", "correct": false}, {"label": "D", "text": "22 gauge", "correct": true}], "correct_answer": "D. 22 gauge", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with retrosternal chest pain radiating to the jaw and dysphagia. A barium swallow was performed, and the following image was shown. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Infectious esophagitis", "correct": false}, {"label": "B", "text": "Diffuse esophageal spasm", "correct": true}, {"label": "C", "text": "Barrette’s esophagus", "correct": false}, {"label": "D", "text": "Esophageal stricture", "correct": false}], "correct_answer": "B. Diffuse esophageal spasm", "question_images": ["https://image.prepladder.com/content/wioYWfJNU8OnR8vTnpy81746008993.png"], "explanation_images": [], "explanation": "<p>Correct Option B) &lt;span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\"&gt;Diffuse&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;esophageal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The provided barium swallow indicates", "options": [{"label": "A", "text": "Achalasia cardia", "correct": true}, {"label": "B", "text": "Diffuse esophageal spasm", "correct": false}, {"label": "C", "text": "Nutcracker oesophagus", "correct": false}, {"label": "D", "text": "Hypertensive lower esophageal sphincter", "correct": false}], "correct_answer": "A. Achalasia cardia", "question_images": ["https://image.prepladder.com/content/WIDhYlmqA2V7aVhTxwOO1746009079.png"], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"b032d2af58169277718080a9060b14\"&gt;Achalasia&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions has a barium enema as shown in the picture below?", "options": [{"label": "A", "text": "Multiple colonic polyps", "correct": false}, {"label": "B", "text": "Ulcerative colitis", "correct": false}, {"label": "C", "text": "Diverticulosis", "correct": true}, {"label": "D", "text": "Irritable bowel syndrome", "correct": false}], "correct_answer": "C. Diverticulosis", "question_images": ["https://image.prepladder.com/content/q2kNu4DjiYT08F8jiOTv1747911039.png"], "explanation_images": ["https://image.prepladder.com/content/12B1ndlHSINLV7nBdiHg1746009189.png", "https://image.prepladder.com/content/iXw6SVdnZwP2u5uk4KTe1747911051.png"], "explanation": "<p>Correct answer C) Diverticulosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diverticulosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of small, bulging pouches (diverticula) in the colon, most commonly in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"464\" src=\"https://image.prepladder.com/content/12B1ndlHSINLV7nBdiHg1746009189.png\" width=\"464\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diet:</strong> A low-fiber diet increases <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> pressure.</p>\n<p><strong>Age:</strong> More common in those over 60.</p>\n<p><strong>Genetics:</strong> Family history may increase risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased pressure:</strong> High <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> pressure causes weak spots to bulge.</p>\n<p><strong>Weak <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> wall:</strong> Weak areas, especially where blood vessels enter the mucosa, are <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to forming diverticula.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>False diverticula:</strong> Involve only the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and submucosa.</p>\n<p><strong>Multiple and acquired: </strong>Typically multiple and not congenital.</p>\n<p><strong>Location:</strong> Most commonly in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon, along the mesenteric aspect.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often asymptomatic; may include mild <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort, bloating, and changes in <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colonoscopy:</strong> Direct visualization.</p>\n<p><strong>CT Scan:</strong> Detailed images of the colon.</p>\n<p><strong>Barium enema:</strong> Less common, shows a characteristic sawtooth appearance</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://abdominalkey.com/diverticular-disease-of-the-colon-2/\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/iXw6SVdnZwP2u5uk4KTe1747911051.png\" width=\"3426\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diet: Increase fiber intake.</p>\n<p>Hydration: Drink plenty of fluids.</p>\n<p>Exercise: Promotes healthy <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower GI Bleed: Common cause of lower <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A gross specimen of the colon obtained from a 14-year-old boy is shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Crohn's disease", "correct": false}, {"label": "B", "text": "Familial adenomatous polyposis (FAP)", "correct": true}, {"label": "C", "text": "Lynch syndrome", "correct": false}, {"label": "D", "text": "Juvenile polyposis syndrome", "correct": false}], "correct_answer": "B. Familial adenomatous polyposis (FAP)", "question_images": ["https://image.prepladder.com/content/jF5GWd9ziLkdthtqIBg41746017128.png"], "explanation_images": ["https://image.prepladder.com/content/qUC9ieDlGQhwT6koeP6K1746017155.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a routine check-up, an elderly male was discovered to have a rectal mass during a digital rectal examination, indicating the possibility of rectal carcinoma. Despite normal bowel habits, the next course of action for managing this patient should be:", "options": [{"label": "A", "text": "CT scan of the abdomen", "correct": false}, {"label": "B", "text": "Rigid sigmoidoscopy and biopsy", "correct": false}, {"label": "C", "text": "Full colonoscopy and biopsy", "correct": true}, {"label": "D", "text": "Barium enema", "correct": false}], "correct_answer": "C. Full colonoscopy and biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Full &lt;span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\"&gt;colonoscopy&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presented with a low-grade fever of 1-week duration associated with loss of appetite and weight loss. Barium meal follow-through image of the patient is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Ileocaecal TB", "correct": true}, {"label": "B", "text": "Ulcerative colitis", "correct": false}, {"label": "C", "text": "Crohn’s disease", "correct": false}, {"label": "D", "text": "Carcinoma caecum", "correct": false}], "correct_answer": "A. Ileocaecal TB", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Ileocaecal TB</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> affecting the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> region, the most common site of <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> TB.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Why the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">Ileocecal</span> Region?</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rich in <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue, slow transit time, and increased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> of <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> bacilli.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right lower <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RLQ) pain, weight loss, fever, diarrhoea/constipation, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnoses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crohn’s disease, appendicitis, <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer, lymphoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RLQ tenderness, <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass, signs of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (in severe cases).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound/CT scan</strong>: <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> wall thickening, lymphadenopathy, ascites, strictures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colonoscopy</strong>: Ulcers, nodularity, strictures in the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> region.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caseating granulomas, <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) on Ziehl-Neelsen stain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definitive Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFB culture, <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> for <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-TB Therapy (ATT)</strong>: <strong>Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (2 months), followed by <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> + <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (4 months).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications for Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bowel obstruction, perforation, abscess, stricture, and unresponsiveness to ATT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (if necessary), <span class=\"customMeta\" data-dictid=\"7c91935f971692777199558dedd3cb\">stricturoplasty</span> (for non-resectable strictures).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man arrives at the emergency department with a concern of vomiting blood. He mentions a recent pattern of excessive alcohol consumption. Upon examination, his vital signs are steady, and he has a pale appearance. There are no indications of ongoing bleeding. The results of his liver function tests are within the normal range. To further assess the situation, an upper gastrointestinal endoscopy is scheduled. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Esophageal varices", "correct": false}, {"label": "B", "text": "Gastric ulcer", "correct": false}, {"label": "C", "text": "Mallory-Weiss tear", "correct": true}, {"label": "D", "text": "Alcoholic gastritis", "correct": false}], "correct_answer": "C. Mallory-Weiss tear", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gmxacvUbYNClv5tqhrAX1747911490.png"], "explanation": "<p>Correct answer C) Mallory-W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following accurately represents Bormann's classification for gastric carcinoma?", "options": [{"label": "A", "text": "Type I: Polypoid tumor with a small ulcerated component", "correct": true}, {"label": "B", "text": "Type II: Ulcerated tumor with infiltrative margins", "correct": false}, {"label": "C", "text": "Type III: Diffusely infiltrative tumor with linitis plastica appearance", "correct": false}, {"label": "D", "text": "Type IV: Mucinous carcinoma with extensive peritoneal metastases", "correct": false}], "correct_answer": "A. Type I: Polypoid tumor with a small ulcerated component", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Type I: &lt;span class=\"customMeta\" data-dictid=\"a3c898fa9e1692777196b39e3bf93c\"&gt;Polypoid&lt;/span&gt; tumor with a small ulcerated component:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bormann Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Macroscopic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I (Polypoid type)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polypoid or fungating mass</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Well-defined borders</strong>, grow into the lumen, minimal invasion into the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> wall, mand ay have a <strong>small ulcerated component</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II (Ulcerated tumor with distinct borders)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcerated <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with raised margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clearly defined <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> edges</strong>, but <strong>not deeply penetrating</strong> into surrounding tissues. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III (Ulceroinfiltrative type)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> with <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irregular and poorly defined borders</strong>, penetrate deeper into the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> wall, more aggressive than Type II.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV (Diffuse/Infiltrative type – <span class=\"customMeta\" data-dictid=\"00eec64d051692777191b76ee079b7\">Linitis</span> Plastica)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse thickening of the stomach wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infiltrative growth without a <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> mass</strong>, causes <strong>\"a leather bottle stomach\"</strong> appearance, commonly associated with <strong>signet-ring cell carcinoma</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents to the emergency department with abdominal pain and vomiting. He reports a 2-day history of constipation and bloating. On examination, he appears uncomfortable, and his abdomen is distended with high-pitched bowel sounds. X-ray reveals dilated loops of the small bowel. What is the most likely cause of his symptoms?", "options": [{"label": "A", "text": "Colonic malignancy", "correct": false}, {"label": "B", "text": "Small bowel obstruction", "correct": true}, {"label": "C", "text": "Acute pancreatitis", "correct": false}, {"label": "D", "text": "Gastric ulcer", "correct": false}], "correct_answer": "B. Small bowel obstruction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) Small &lt;span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\"&gt;bowel&lt;/span&gt; obstruction</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:596px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (SBO)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adhesions<strong> (Most common)</strong></li>\n<li>Malignancy</li>\n<li>Metastasis</li>\n<li>Peritoneal carcinomatosis</li>\n<li>Hernia</li>\n<li>Crohn's Disease</li>\n<li>Tb</li>\n<li>PID</li>\n<li>Post radiotherapy</li>\n<li>Cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgeries with High Risk of <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (SBO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic surgeries (Highest risk)</strong></li>\n<li>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancies Responsible for SBO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metastasis</li>\n<li>Peritoneal carcinomatosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following findings of colonoscopy is highly malignant?", "options": [{"label": "A", "text": "Multiple flat polyps about 100", "correct": true}, {"label": "B", "text": "Single pedunculated polyp", "correct": false}, {"label": "C", "text": "Multiple pedunculated polyps", "correct": false}, {"label": "D", "text": "Solitary flat polyp", "correct": false}], "correct_answer": "A. Multiple flat polyps about 100", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NAMyjJuOEbJEbkT5Eo7M1746076108.png"], "explanation": "<p>Correct answer A) Multiple flat &lt;span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\"&gt;polyp&lt;/span&gt; abou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes McBurney's point in cases of acute appendicitis?", "options": [{"label": "A", "text": "McBurney point is located in the left lower quadrant of the abdomen.", "correct": false}, {"label": "B", "text": "McBurney point corresponds to the site of maximal tenderness in acute appendicitis.", "correct": true}, {"label": "C", "text": "McBurney point is used to assess rebound tenderness in acute appendicitis.", "correct": false}, {"label": "D", "text": "McBurney point is located at the umbilicus in acute appendicitis.", "correct": false}], "correct_answer": "B. McBurney point corresponds to the site of maximal tenderness in acute appendicitis.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) McBurney point corresponds to the site of &lt;span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\"&gt;maximal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\"&gt;tenderness&lt;/span&gt; in &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;acute&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who has been experiencing fever and pain in the lower right abdomen for the past 5 days, with the presence of a tender mass in the right iliac fossa and an elevated leukocyte count?", "options": [{"label": "A", "text": "Appendicitis", "correct": true}, {"label": "B", "text": "Hydronephrosis", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Carcinoma colon", "correct": false}], "correct_answer": "A. Appendicitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a female patient who presents with a mass in the inguinal area that can be reduced from the deep inguinal ring accompanied by a gurgling sound?", "options": [{"label": "A", "text": "Direct inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Pantaloon hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZTRDM4mXL1kd8FgzzUe11746077174.png"], "explanation": "<p>Correct answer B) &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through Hesselbach's triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> Processus vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from testis</li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are true about Crohn’s disease except", "options": [{"label": "A", "text": "Rectum is involved", "correct": true}, {"label": "B", "text": "Serpiginous ulcers are formed", "correct": false}, {"label": "C", "text": "Transmural involvement", "correct": false}, {"label": "D", "text": "Recurrence is more common", "correct": false}], "correct_answer": "A. Rectum is involved", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KwiGOR3Rc2e1QMrfFoWl1746081925.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmural involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inflammation extends through the entire <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serpiginous ulcers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep, <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> ulcers give a <strong>cobblestone appearance</strong> to the mucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skip lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Areas of <strong>normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> interspersed</strong> with diseased segments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More common than <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis, even after surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rectal sparing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unlike <strong>ulcerative colitis</strong>, Crohn’s disease rarely affects the rectum</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true about colon cancer? 1. Right and left colon cancers can behave differently 2. Colon cancers can be hereditary 3. Colon cancer risk can be reduced by metformin 4. Colon cancers frequently metastasize to the liver", "options": [{"label": "A", "text": "1, 2 and 3 only", "correct": false}, {"label": "B", "text": "2, 3 and 4 only", "correct": false}, {"label": "C", "text": "2 and 4 only", "correct": false}, {"label": "D", "text": "1, 2, 3 and 4", "correct": true}], "correct_answer": "D. 1, 2, 3 and 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Statement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True/False</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Right and left <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancers can behave differently.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right-sided <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer</strong> (proximal) is more likely to present with <strong>anemia, <span class=\"customMeta\" data-dictid=\"c8d9b6cbbb1692777194c4bc31f01f\">occult</span> bleeding, and larger <span class=\"customMeta\" data-dictid=\"a3c898fa9e1692777196b39e3bf93c\">polypoid</span> tumors</strong>, while <strong>left-sided <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer</strong> (distal) presents with <strong>obstruction, hematochezia, and napkin-ring lesions</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> cancers can be hereditary.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary Nonpolyposis <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">Colorectal</span> Cancer (HNPCC/Lynch Syndrome)</strong> and <strong>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">Adenomatous</span> <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">Polyposis</span> (FAP)</strong> are genetic syndromes associated with increased <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> cancer risk can be <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by metformin.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Studies suggest that <strong>metformin reduces <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance and suppresses <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer cell proliferation</strong>, <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> the risk, especially in <strong>diabetic patients</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> cancers frequently <span class=\"customMeta\" data-dictid=\"c329085d1b1692777192eda410629f\">metastasize</span> to the liver.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>portal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> system drains the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> to the liver</strong>, making it the most common site of metastasis. Other common sites include <strong>lungs and peritoneum</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nonclinical question: Match the following: 1. Hirschsprung’s disease A. MRCP 2. Posterior urethral valve B. CT scan 3. Choledochal cyst C. Rectal biopsy 4. Intussusception D. Micturating cystourethrogram", "options": [{"label": "A", "text": "1-C, 2-D, 3-B, 4-A", "correct": false}, {"label": "B", "text": "1-A, 2-D, 3-B, 4-C", "correct": false}, {"label": "C", "text": "1-C, 2-D, 3-A, 4-B", "correct": true}, {"label": "D", "text": "1-D, 2-C, 3-A, 4-B", "correct": false}], "correct_answer": "C. 1-C, 2-D, 3-A, 4-B", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) 1-C, 2-D, 3-A, 4-B</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hirschsprung’s disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rectal biopsy</strong> (C)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gold standard test to confirm <strong>absence of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells</strong> in the <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> submucosa, leading to functional obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior urethral valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Micturating <span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\">cystourethrogram</span> (MCUG)</strong> (D)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identifies <strong>posterior urethral obstruction</strong> due to <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <strong>valves in male infants</strong>, causing <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> and hydronephrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Choledochal cyst</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRCP (Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> Cholangiopancreatography)</strong> (A)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best non-invasive <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <strong>biliary tree anomalies</strong>, including <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of the common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intussusception</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT scan</strong> (B) (Ultrasound is first-line for children)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT scan shows the \"target sign\"</strong> in adults, while <strong>USG is preferred for children</strong>, showing characteristic <span class=\"customMeta\" data-dictid=\"9bb62139a81692777184648bfef564\">concentric</span> rings.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures are incised by a surgeon during an appendectomy performed initially with a gridiron incision? 1. External oblique 2. Internal oblique 3. Transversus abdominis 4. Rectus abdominis", "options": [{"label": "A", "text": "1, 3, 4", "correct": false}, {"label": "B", "text": "2, 3, 4", "correct": false}, {"label": "C", "text": "1, 2, 3", "correct": true}, {"label": "D", "text": "1, 2, 4", "correct": false}], "correct_answer": "C. 1, 2, 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v06uHo1U8JZA1OcoA7s01745560208.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>McBurney's incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Centered on McBurney's point, perpendicular to the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ASIS line</li>\n<li>Junction of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 1/3 from <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> &amp; <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 2/3 from ASIS</li>\n<li>McBurney's point corresponds to the base of the appendix</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Aka Grid iron <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / McArthur incision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lanz incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placed transversely 2 cm below the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> on the line joining the midpoint of the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> to the midpoint of the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Cosmetically better incision</li>\n<li>Aka Modified McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / Rocky Davis <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / Bikini <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> (good <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rutherford-Morrison incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extension of McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for retrocecal appendicitis</li>\n<li>Upward &amp; laterally by cutting conjoint tendon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle cutting incision</li>\n<li>Preferred for retrocecal appendix</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby playing unsupervised was brought with complaints of difficulty in swallowing for the last few hours. The x-ray image is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Foreign body in the trachea", "correct": false}, {"label": "B", "text": "Foreign body in the esophagus", "correct": true}, {"label": "C", "text": "Artifact", "correct": false}, {"label": "D", "text": "Soft tissue calcification in the neck", "correct": false}], "correct_answer": "B. Foreign body in the esophagus", "question_images": ["https://image.prepladder.com/notes/VGUfYaAGU8TY4OpCDGBe1746450861.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Emergency</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (inability to handle oral secretions)</li>\n<li>Disk batteries</li>\n<li>Sharp-pointed objects</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> removal<strong> </strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urgent </strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blunt objects</li>\n<li>Incomplete obstruction</li>\n<li>Multiple magnets (or single <span class=\"customMeta\" data-dictid=\"883e21a28016927771915738a46f85\">magnet</span> plus another ferromagnetic object within <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> reach)</li>\n<li>Coins</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endoscopic removal within 12 to 24 hours<strong> </strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non Urgent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Objects in stomach &gt;2.5cm diameter</li>\n<li>Disc battery in the stomach for up to 48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> if asymptomatic</li>\n<li>Blunt objects that fail to pass the stomach in 3-4 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Observation<strong> </strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was found to have a mass arising from the antrum of the stomach, which involves the head of the pancreas and metastasis to the right lobe of the liver. How will you manage this patient?", "options": [{"label": "A", "text": "Palliative gastrojejunostomy followed by chemotherapy", "correct": true}, {"label": "B", "text": "Radical gastrectomy", "correct": false}, {"label": "C", "text": "Whipple's procedure", "correct": false}, {"label": "D", "text": "Gastrectomy with right hepatectomy", "correct": false}], "correct_answer": "A. Palliative gastrojejunostomy followed by chemotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a hernia medial to the inferior epigastric artery. What is the most likely diagnosis and appropriate management for the same?", "options": [{"label": "A", "text": "Direct hernia and Bassini repair", "correct": false}, {"label": "B", "text": "Direct hernia and Lichtenstein mesh repair", "correct": true}, {"label": "C", "text": "Indirect hernia and Bassini repair", "correct": false}, {"label": "D", "text": "Indirect hernia and Lichtenstein mesh repair", "correct": false}], "correct_answer": "B. Direct hernia and Lichtenstein mesh repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TGCeSJgMFrYGnGIS5Jru1745476695.png", "https://image.prepladder.com/content/WPQS38AEKyC5RRSTYuI41745476695.png", "https://image.prepladder.com/content/HfzCeD8Q4hueXSim6cGo1745476695.png", "https://image.prepladder.com/content/k2HjF9GXLAJkYYrsSbM71745476695.png", "https://image.prepladder.com/content/k1lm3DRog4dc9LIhhqi51745476695.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates. <strong>(Option A ruled out)</strong></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Anpol42\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bassini_Operation._The_first_suture.jpg\" data-tags=\"\" height=\"298\" src=\"https://image.prepladder.com/content/TGCeSJgMFrYGnGIS5Jru1745476695.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shouldice Repair:</strong> involves a <strong>four-layer repair</strong> (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kumar hari rajah M. Somanathan\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"142\" src=\"https://image.prepladder.com/content/WPQS38AEKyC5RRSTYuI41745476695.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TEP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TAPP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgery done <strong>above the</strong> peritoneum</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgery done<strong> beneath the</strong> peritoneum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and peritoneal complications.</li>\n<li>Reduced risk of adhesions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Larger working space</li>\n<li>Better visualisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Smaller working spaces can make the procedure more technically challenging.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A higher risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> formation due to entry into the peritoneal cavity.</li>\n<li>Potential for increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain compared to TEP.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through <strong>Hesselbach's <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> Processus vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from testis</li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p style=\"text-align: center;\"><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with rectal prolapse underwent surgery. The postoperative image is given below. Identify the Procedure.", "options": [{"label": "A", "text": "Stapled hemorrhoidopexy", "correct": false}, {"label": "B", "text": "Well’s procedure", "correct": false}, {"label": "C", "text": "Thiersch wiring", "correct": true}, {"label": "D", "text": "Altemeier repair", "correct": false}], "correct_answer": "C. Thiersch wiring", "question_images": ["https://image.prepladder.com/notes/N1DKkVAJc2dLMJS97v1m1746452231.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h5><strong>Aspect</strong></h5>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h5><strong>Abdominal Rectopexy</strong></h5>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h5><strong>Perineal Rectopexy</strong></h5>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prosthetic or <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> rectopexy-anterior/ posterior- <strong>Well's, Ripstein</strong></li>\n<li>Suture rectopexy- <strong>Lahaut</strong></li>\n<li>Anterior Resection</li>\n<li>Resection Rectopexy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mucosal sleeve <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (<strong>Delrome's</strong>)</li>\n<li>Perineal recto <span class=\"customMeta\" data-dictid=\"c571bd042816927771984a81e88895\">sigmoidectomy</span> (<strong>Altemeier's</strong>)</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> of <strong>Lockhardt-Mummery </strong></li>\n<li><strong>Mickulicz Miles</strong> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> <span class=\"customMeta\" data-dictid=\"ebf9c40d2b16927772009a937efb25\">transanal</span> recto sigmoidectomy</li>\n<li>Anal encircling (<strong>Thiersch</strong>) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fixation of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> provides adequate tension to prevent recurrence.</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> options (laparoscopic or robotic) offer benefits in pain control, hospital stay, and recovery time</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality, suitable for elderly or medically unfit patients.</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Requires extensive <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> and fixation, which may have higher <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> (10%-33%).</li>\n<li>Risk of mesh-related complications such as erosion, infection, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, and migration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approaches</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Partial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complete</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mucosal</li>\n<li>There is no <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer.</li>\n<li>It is the most common type of rectal prolapse.</li>\n<li>History of mass per anum, It is pink in colour and circumferential.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete-full thickness.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> contains all layers of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> (i.e. including the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer).</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> as mass <span class=\"customMeta\" data-dictid=\"be836a0f5e169277719538e60bc715\">per anum</span> circumferentially, which is red in colour. Mass is usually <span class=\"customMeta\" data-dictid=\"7b497fabf51692777197384bc1248f\">reducible</span> and painless.</li>\n<li>It may be associated with <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> (uterine procidentia) in females.</li>\n<li>Fecal <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (75%) is very common.</li>\n<li>Bleeding can occur because of the congestion.</li>\n<li>Sepsis, discharge, fever, and anaemia are other features.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding Peutz-Jeghers syndrome is correct? 1. Autosomal dominant disease 2. Defect in the STK11 gene 3. Melanin spots on digits and perianal skin 4. Autosomal recessive 5. Congenital hypertrophy of retinal pigment epithelium is seen", "options": [{"label": "A", "text": "2, 4 and 5", "correct": false}, {"label": "B", "text": "1, 2 and 3", "correct": true}, {"label": "C", "text": "1, 3 and 4", "correct": false}, {"label": "D", "text": "2, 3 and 5", "correct": false}], "correct_answer": "B. 1, 2 and 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yvzPBkh5IWjnNqVtbz2b1745579015.png", "https://image.prepladder.com/notes/d8zVA2G3oZiQ5dQ5PO3d1746602839.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents to the ER with severe abdominal pain. On examination, his HR is 110 bpm, BP-88/60 mmHg. Guarding is present on per abdomen examination. Erect abdominal X-ray is shown below. Which of the following would you proceed with for the management of this case? A. USG abdomen B. IV fluids C. Exploratory laparotomy D. Elective surgery E. Conservative management", "options": [{"label": "A", "text": "B &amp;amp; C", "correct": true}, {"label": "B", "text": "B &amp;amp; D", "correct": false}, {"label": "C", "text": "A, B &amp;amp; C", "correct": false}, {"label": "D", "text": "A, B &amp;amp; E", "correct": false}], "correct_answer": "A. B &amp; C", "question_images": ["https://image.prepladder.com/content/SoU06gyd4ZniY2zWy0NU1745580388.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following correctly.", "options": [{"label": "A", "text": "CA bladder", "correct": false}, {"label": "B", "text": "Right inguinal hernia", "correct": false}, {"label": "C", "text": "Left inguinal hernia", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Left inguinal hernia", "question_images": ["https://image.prepladder.com/notes/RbpONxIVBGNOr3KAjEst1746602622.png"], "explanation_images": ["https://image.prepladder.com/content/wMjt3JFzR3iGV8Ua3DV51745580545.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through <strong>Hesselbach's <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral</strong> to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medial</strong> to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> Processus vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from testis</li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>—</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dennis M. DePace\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Common_Sites_of_Lower_Abdominal_Hernias.jpg\" data-tags=\"\" height=\"497\" src=\"https://image.prepladder.com/content/wMjt3JFzR3iGV8Ua3DV51745580545.png\" width=\"512\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man in his middle age arrives with a gradual onset of challenges while swallowing both solid and liquid substances over the course of 8 months. The results of a barium swallow test conducted are provided below. What additional examinations should be conducted for this individual?", "options": [{"label": "A", "text": "Upper GI endoscopy &amp;amp; Manometry", "correct": true}, {"label": "B", "text": "Upper GI endoscopy &amp;amp; PET scan", "correct": false}, {"label": "C", "text": "Upper GI endoscopy &amp;amp; CECT", "correct": false}, {"label": "D", "text": "Upper GI endoscopy &amp;amp; 24-hour pH monitoring", "correct": false}], "correct_answer": "A. Upper GI endoscopy &amp; Manometry", "question_images": ["https://image.prepladder.com/content/eO8cVm6WlCmNLKzRuseY1745582239.png"], "explanation_images": ["https://image.prepladder.com/content/t5qirUe7TqJJZYOTAHtH1745582276.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Achalasia cardia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterised by the progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall, which leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and failure of the lower oesophagal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gold Standard</strong>: This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the esophagus.</p>\n<ul>\n<li>Elevated resting LES pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete LES relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the LES (<strong>Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance/ Pencil tip appearance/ Rat tail appearance</strong>).</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Achalasie_Stadium_2.jpg\" data-tags=\"\" height=\"535\" src=\"https://image.prepladder.com/content/t5qirUe7TqJJZYOTAHtH1745582276.png\" width=\"351\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris, It is important to rule out other causes of <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> such as tumors.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is diagnosed with congenital hypertrophic pyloric stenosis. Which among the following can be seen in this child? A. Bilious vomiting B. Visible peristalsis from left to right C. Hypochloremia and hypokalemia D. Metabolic alkalosis", "options": [{"label": "A", "text": "B, C and D", "correct": true}, {"label": "B", "text": "A and D only", "correct": false}, {"label": "C", "text": "A, B and D", "correct": false}, {"label": "D", "text": "A, B, C and D", "correct": false}], "correct_answer": "A. B, C and D", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uZYdQbKbQdqDtNmhlFjP1747731353.png", "https://image.prepladder.com/content/34T6m8JYobBuQKnt3fes1747731376.png", "https://image.prepladder.com/content/JLXWG8ur7jhV1CdJh2SD1745582860.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Congenital <span class=\"customMeta\" data-dictid=\"2cf4f27ae616927771895f410747ad\">hypertrophic pyloric stenosis</span> (CHPS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a condition involving <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> of the pyloric muscle, leading to <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants, typically between 2 - 6 weeks of age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> Projectile, non-bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> after feeds, starting around 2 to 6 weeks of age. <strong>(Statement A ruled out)</strong>\n<ul>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> leads to <strong>dehydration, <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> </strong>and <strong>hypochloremic <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> </strong>because the body loses <strong>hydrochloric acid (HCl)</strong> in the vomitus.</li>\n</ul>\n</li>\n<li><strong>Physical Examination: Visible <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> from left to right</strong> and a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> “olive-shaped” mass in the epigastric region.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound (USG) </strong>is the Investigation of choice for CHPS, characterised by\n\t\t\t\t<ul>\n<li>Pyloric muscle <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of<strong> &gt; 3 mm </strong></li>\n<li>Pyloric length <strong>&gt; 14 mm </strong></li>\n<li>The pyloric channel appears elongated and thickened <strong>(10-14 mm)</strong></li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/uZYdQbKbQdqDtNmhlFjP1747731353.png\" width=\"4167\"/></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr Laughlin Dawes\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Pyloric_stenosis#/media/File:Pyloric-stenosisLocal.jpg\" data-tags=\"\" height=\"3963\" src=\"https://image.prepladder.com/content/34T6m8JYobBuQKnt3fes1747731376.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Contrast Studies (Upper GI Series): </strong>Less frequently used, demonstrating the classic <strong> \"string sign\"</strong> with a thin line of contrast through the<strong> elongated and narrowed pyloric channel and <span class=\"customMeta\" data-dictid=\"6cad6b72af16927771868f07a43773\">delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</span> without duodenal dilation. </strong></li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pritviraj SK, Devasenathipathy Kandasamy, Manisha Jana, Raju Sharma, Arun Kumar\" data-hash=\"\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Congenital-hypertrophic-pyloric-stenosis-A-Barium-meal-study-in-early-phase-frontal_fig2_353862388\" data-tags=\"\" height=\"467\" src=\"https://image.prepladder.com/content/JLXWG8ur7jhV1CdJh2SD1745582860.png\" width=\"734\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the Tillaux sign?", "options": [{"label": "A", "text": "Mass is felt in the periumbilical region", "correct": false}, {"label": "B", "text": "Mass is brilliantly transilluminate", "correct": false}, {"label": "C", "text": "Mass is mobile perpendicular to the mesentery attachment line", "correct": true}, {"label": "D", "text": "Fluctuation is positive", "correct": false}], "correct_answer": "C. Mass is mobile perpendicular to the mesentery attachment line", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CSdWNZvAkbPApSEXOb9T1746601796.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mesenteric cysts</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It presents as a painless <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> region.</li>\n<li>Commonly seen in the 2nd decade of life.</li>\n<li>There is <span class=\"customMeta\" data-dictid=\"bac8d4d8b11692777180fccd9b9e73\">a band</span> of <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> in front of the cyst.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tillaux's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> for mesenteric cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A soft, smooth <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> region. <strong>(Option A ruled out)</strong></li>\n<li>Freely mobile mass in a direction perpendicular to the line of the mesentery<strong> (Tillaux Sign) </strong></li>\n<li>A zone of <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> all around. <img alt=\"Tillau\" data-author=\"\" data-hash=\"12316\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/CSdWNZvAkbPApSEXOb9T1746601796.png\"/></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Torsion of cysts can lead to <span class=\"customMeta\" data-dictid=\"061f9a880e1692777202e47dbb3d3f\">volvulus</span> of the adjacent bowel.</li>\n<li>Rupture of the cyst.</li>\n<li>Hemorrhage into the cyst.</li>\n<li>Infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options accurately represents a valid statement concerning retroperitoneal trauma?", "options": [{"label": "A", "text": "All zone 1 injury to be treated conservatively", "correct": false}, {"label": "B", "text": "Zone 3 injury, whether blunt or penetrative, should always be explored", "correct": false}, {"label": "C", "text": "Zone 2 injury with expanding hematoma should be treated surgically", "correct": true}, {"label": "D", "text": "Mattox maneuver is when the ascending colon is mobilized to the right to visualise the Aorta", "correct": false}], "correct_answer": "C. Zone 2 injury with expanding hematoma should be treated surgically", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/k969G8hl9UjVqRpXlSAa1745585654.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most appropriate mesh for use in hernioplasty?", "options": [{"label": "A", "text": "Heavyweight with small pores", "correct": false}, {"label": "B", "text": "Heavyweight mesh with large pores", "correct": false}, {"label": "C", "text": "Lightweight mesh with small pores", "correct": false}, {"label": "D", "text": "Lightweight mesh with large pores", "correct": true}], "correct_answer": "D. Lightweight mesh with large pores", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the European Hernia Society classification, M3 incisional hernia refers to:", "options": [{"label": "A", "text": "Epigastric", "correct": false}, {"label": "B", "text": "Infraumbilical", "correct": false}, {"label": "C", "text": "Umbilical", "correct": true}, {"label": "D", "text": "Suprapubic", "correct": false}], "correct_answer": "C. Umbilical", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/32olvNjA8c4aUo4UOXXk1745485325.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>EHS <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Incisional Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Midline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subxiphoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epigastric</p>\n<p><strong>(Option A ruledout)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Umbilical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infraumbilical</p>\n<p><strong>(Option B ruledout)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suprapubic</p>\n<p><strong>(Option D ruledout)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M5</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Lateral </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcostal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flank</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliac</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lumbar</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L4</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"243\" src=\"https://image.prepladder.com/content/32olvNjA8c4aUo4UOXXk1745485325.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male was diagnosed with achalasia cardia. High-resolution manometry revealed massive, simultaneous, high-pressure contractions of the distal oesophagus. According to the Chicago classification, which type of achalasia does the patient have?", "options": [{"label": "A", "text": "Type II", "correct": false}, {"label": "B", "text": "Type I", "correct": false}, {"label": "C", "text": "Type IV", "correct": false}, {"label": "D", "text": "Type III", "correct": true}], "correct_answer": "D. Type III", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Type III</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chicago <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">Motility</span> (4.0)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Esophageal Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Values</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Achalasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">contractility</span> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, 100% failed peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Esophageal pan-pressurization <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, 100% failed <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> with ≥ 20% pan-esophageal pressurisation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spastic contractions <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, ≥ 20% <span class=\"customMeta\" data-dictid=\"1ce806f0111692777198eedf1b5824\">spastic</span> contractions (DCI &gt; 8,000 mmHg·s·cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. <span class=\"customMeta\" data-dictid=\"eedaf7d1db169277718739bd40e5c5\">Esophagogastric</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">Junction</span> Outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (EGJOO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated integrated <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> pressure (IRP) with preserved peristalsis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, some preserved peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">Spasm</span> (DES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Premature (rapid) contractions with normal IRP<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, ≥ 20% <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> contractions (DL &lt; 4.5 s)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4. Hypercontractile (Jackhammer) Esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extremely strong peristaltic contractions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, ≥ 20% hypercontractile contractions (DCI &gt; 8,000 mmHg·s·cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5. Ineffective <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">Motility</span> (IEM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weak or failed peristalsis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, &gt; 50% ineffective swallows (DCI &lt; 450 mmHg·s·cm for weak peristalsis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6. Absent Contractility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complete lack of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> contractility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, 100% failed peristalsis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a middle-aged man who comes to the emergency department with upper abdominal pain following a large meal? During clinical examination, there is tenderness in the upper abdomen, and a chest X-ray reveals a widening of the mediastinum and pneumomediastinum.", "options": [{"label": "A", "text": "Spontaneous perforation of esophagus", "correct": true}, {"label": "B", "text": "Perforation of peptic ulcer", "correct": false}, {"label": "C", "text": "Foreign body in esophagus", "correct": false}, {"label": "D", "text": "Rupture of emphysematous bulla of the lung", "correct": false}], "correct_answer": "A. Spontaneous perforation of esophagus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\"&gt;Spontaneous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\"&gt;perforation&lt;/span&gt; of esophagu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently encountered neuroendocrine tumour in the pancreas?", "options": [{"label": "A", "text": "Gastrinoma", "correct": false}, {"label": "B", "text": "Somatostatinoma", "correct": false}, {"label": "C", "text": "Insulinoma", "correct": true}, {"label": "D", "text": "VIPoma", "correct": false}], "correct_answer": "C. Insulinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Insulinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A rare, typically<strong> <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumour of the pancreatic <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> cells</strong> that produce <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> insulin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Whipple's Triad:</strong></p>\n<ul>\n<li>Documented low blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels during <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> episodes</li>\n<li>Relief of symptoms upon administration of glucose</li>\n<li>Symptoms often occur during <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> or after exercise</li>\n</ul>\n<p>Symptoms of <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> (e.g., sweating, palpitations, confusion, visual disturbances, seizures)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gold-standard test for diagnosing <span class=\"customMeta\" data-dictid=\"43b7327590169277719092c556b0b6\">insulinoma</span> is a 72-hour fast. </strong></li>\n<li>Combination of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt; 55 mg/dL + <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> level ≥ 3 microUnits/mL + <span class=\"customMeta\" data-dictid=\"c8c9de6f88169277718395f9b4def5\">C peptide</span> level ≥ to 0.6 ng/mL + <span class=\"customMeta\" data-dictid=\"dd9e08ae7c1692777196e4ee59fee9\">proinsulin</span> ≥ 5 pmol/L, + negative <span class=\"customMeta\" data-dictid=\"552023be76169277719976e36a990e\">sulfonylurea</span> level indicates that the <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> is by hyperinsulinemia</li>\n<li><strong>Insulin/glucose ratio &gt; 0.4 is <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> </strong></li>\n<li><strong>Imaging:</strong>\n<ul>\n<li>CT, MRI, EUS</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is the treatment of choice.</li>\n<li>Medical management with <span class=\"customMeta\" data-dictid=\"49eb173e4f1692777186d95adc7021\">diazoxide</span> or <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> for non-surgical candidates or unresectable tumours.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What stage of Hinchey's classification is indicated when a patient with clinical features suggestive of peritonitis presents with diverticular perforation and faecal peritonitis during surgery?", "options": [{"label": "A", "text": "Stage 1", "correct": false}, {"label": "B", "text": "Stage 2", "correct": false}, {"label": "C", "text": "Stage 3", "correct": false}, {"label": "D", "text": "Stage 4", "correct": true}], "correct_answer": "D. Stage 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Stage 4</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Modified Hinchey <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> (Severity of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> diverticulitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild diverticulitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 1 </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ia</strong>: <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">Pericolic</span> inflammation</p>\n<p><strong>Ib</strong>: <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">Pericolic</span> abscess</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 2</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pelvic or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> abscess</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 3</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Purulent peritonitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fecal peritonitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In MEN 1 syndrome, where is the most frequent occurrence of gastrinoma observed?", "options": [{"label": "A", "text": "Jejunum", "correct": false}, {"label": "B", "text": "Ileum", "correct": false}, {"label": "C", "text": "Duodenum", "correct": true}, {"label": "D", "text": "Stomach", "correct": false}], "correct_answer": "C. Duodenum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Duodenu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> (MEN Type I)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumors</strong></p>\n<p style=\"text-align: center;\"><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid adenoma</strong></p>\n<p>(Most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> and ↑ Ca)</li>\n<li>All the four glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the given barium swallow film show?", "options": [{"label": "A", "text": "Aortic aneurysm", "correct": false}, {"label": "B", "text": "Pharyngeal pouch", "correct": true}, {"label": "C", "text": "Carotid body tumour", "correct": false}, {"label": "D", "text": "Esophageal carcinoma", "correct": false}], "correct_answer": "B. Pharyngeal pouch", "question_images": ["https://image.prepladder.com/content/TS8sDKCL86TeGi3JG8sP1747216590.png"], "explanation_images": ["https://image.prepladder.com/content/CitDWLLKOaMjaQ1MeQ4Y1747216601.png", "https://image.prepladder.com/content/lC4XVms6ve2vLd3MPzp61748377745.png", "https://image.prepladder.com/content/CvJAFmiv2BegEOUbyU621748377719.png", "https://image.prepladder.com/content/0JLgk2Hmr8JkmDNFPuZ51746515531.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Zenker's diverticulum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia is the most prominent feature appears when the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> gets filled with food and presses on the oesophagus.</li>\n<li>Gurgling sound is produced on swallowing.</li>\n<li>Regurgitation at night from undigested food causes <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia.</li>\n<li>Halitosis(Chronic bad breathe)</li>\n<li>Malnourished due to dysphagia.</li>\n<li>Associated <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">hiatus</span> hernia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Barium swallow </strong>provides information regarding the size, location, and character of the mucosal lining.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/CitDWLLKOaMjaQ1MeQ4Y1747216601.png\" width=\"265\"/></p>\n<ul>\n<li><strong>Endoscopy</strong> reveals <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and pooling of food in the diverticulum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> and <span class=\"customMeta\" data-dictid=\"07bb7766221692777185a58cad9233\">cricopharyngeal</span> myotomy</strong> was done through a <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> approach.</li>\n<li><strong>Dohlman’s procedure: </strong>Partition wall between the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is exposed and divided by <span class=\"customMeta\" data-dictid=\"24bfc6e0cc16927771862d94b32d73\">diathermy</span> through a weerda scope.</li>\n<li><strong>Endoscopic laser treatment:</strong> Partition wall between the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is exposed and divided by CO2 laser using an endoscope. This procedure is known to have fewer recurrences and faster improvement in symptoms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man presents with a gradual onset of swallowing difficulties for both solid and liquid foods, persisting for 8 months. The barium swallow test results are presented below. The patient undergoes upper gastrointestinal endoscopy and manometry. Which of the following statements is not true regarding this condition?", "options": [{"label": "A", "text": "Loss of lower esophageal sphincter pressure causing reflux", "correct": true}, {"label": "B", "text": "&amp;lt;75% relaxation of the lower esophageal sphincter", "correct": false}, {"label": "C", "text": "It is a primary motility disorder", "correct": false}, {"label": "D", "text": "Esophageal peristalsis is absent", "correct": false}], "correct_answer": "A. Loss of lower esophageal sphincter pressure causing reflux", "question_images": ["https://image.prepladder.com/content/4y3yp49d1lZC9VfxxApT1746975818.png"], "explanation_images": ["https://image.prepladder.com/content/VFPDmBxrNcTSD4sZvN0Q1746975875.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Achalasia cardia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a primary <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> disorder <strong>(Option B ruled out) </strong>characterised by the progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall, which leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and failure of the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing</p>\n<p><strong>(Option A &amp; D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gold Standard</strong>: This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the esophagus.</p>\n<ul>\n<li>Elevated resting LES pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete LES relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the LES (Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance/ Pencil tip appearance/ Rat tail appearance).</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Achalasie_Stadium_2.jpg\" data-tags=\"\" height=\"522\" src=\"https://image.prepladder.com/content/VFPDmBxrNcTSD4sZvN0Q1746975875.png\" width=\"281\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris. It is important to rule out other causes of dysphagia, such as tumours.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the subsequent course of action for managing a 35-year-old woman who has been experiencing swelling in her right groin for the past six months, as determined during her arrival at the emergency department? Upon examination, a reducible hernia is observed in the right groin without any signs of strangulation.", "options": [{"label": "A", "text": "Exploratory laparotomy", "correct": false}, {"label": "B", "text": "Reduce the swelling and later observe", "correct": false}, {"label": "C", "text": "Reduce the swelling and do elective surgery", "correct": true}, {"label": "D", "text": "Do a CT abdomen", "correct": false}], "correct_answer": "C. Reduce the swelling and do elective surgery", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment Approaches for <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lockwood's </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open, Low</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incision below <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> crease, directly over hernia; Elective repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>McEvedy's </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open, High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oblique <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> above inguinal ligament</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lotheissen's</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open, High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Access through the inguinal canal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>McVay </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suturing <span class=\"customMeta\" data-dictid=\"c9ac184b521692777185f5b6c8e958\">conjoint tendon</span> to Cooper's ligament</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TEP (Totally Extraperitoneal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Laparoscopic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh placement without entering the peritoneal cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TAPP (Transabdominal Preperitoneal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Laparoscopic</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh placement after entering the peritoneal cavity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The likely diagnosis for a newborn infant presenting with signs of intestinal obstruction, as indicated by the x-ray image and CT abdomen showing an annular pancreas, is:", "options": [{"label": "A", "text": "Jejunoileal atresia", "correct": false}, {"label": "B", "text": "Esophageal atresia", "correct": false}, {"label": "C", "text": "Duodenal atresia", "correct": true}, {"label": "D", "text": "Colonic atresia", "correct": false}], "correct_answer": "C. Duodenal atresia", "question_images": ["https://image.prepladder.com/content/Q6bErUC36xNmsINRI6Wl1746982676.png"], "explanation_images": ["https://image.prepladder.com/content/cBSeIGAyPNgQrNKTBZc01746982718.png", "https://image.prepladder.com/notes/pkRanHgtOVTzL1yR4reL1747998288.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duodenal Atresia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Failed recanalisation of intestinal <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> during gestation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prematurity (50%)</li>\n<li>Congenital anomalies (heart disease, malrotation, <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> pancreas, etc.)</li>\n<li>Chromosomal abnormalities (e.g., <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 21)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> without <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distention.</li>\n<li>Symptoms typically present within the first few days of life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confirmed by the<strong> double bubble sign</strong> on the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> and <span class=\"customMeta\" data-dictid=\"d554413593169277719693b8e38638\">prenatal</span> ultrasonography.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial:</strong> Nasogastric <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> and IV fluids</li>\n<li><strong>Definitive:</strong> Surgical repair<strong> (Duodenoduodenostomy)</strong></li>\n<li><strong>Postoperative care:</strong> Gastrostomy tube, nutritional support</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who underwent Nissen’s fundoplication was seen in the ward during evening rounds. He is asymptomatic at present and has stable vitals. What is the next line of management for this patient?", "options": [{"label": "A", "text": "Nasogastric tube to prevent gas bloat syndrome", "correct": false}, {"label": "B", "text": "Insert chest tube to prevent pneumothorax", "correct": false}, {"label": "C", "text": "Monitor vitals", "correct": true}, {"label": "D", "text": "Imaging to rule out perforation", "correct": false}], "correct_answer": "C. Monitor vitals", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of GERD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lifestyle Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevate the head of the bed</li>\n<li>Avoid lying down after meals</li>\n<li>Quit smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Antacids: </strong>Neutralize stomach acid</li>\n<li><strong>H2-receptor antagonists: </strong>Ranitidine, Famotidine</li>\n<li><strong>Proton pump inhibitors (PPIs): </strong>Omeprazole, Esomeprazole</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antireflux operation: </strong>3 components</p>\n<ul>\n<li>Restoration of the <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> segment of the esophagus</li>\n<li>Crural repair</li>\n<li>Reinforcement of the <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> by the upper stomach or prosthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundoplication: </strong>A <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure to wrap the top of the stomach around the lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> to strengthen the sphincter.</p>\n<ul>\n<li><strong>Complete <span class=\"customMeta\" data-dictid=\"5ef90c9b94169277720333361d520e\">fundoplication</span> (Nissen)</strong></li>\n<li><strong>Partial fundoplication: Posteriorly (Toupet) or Anteriorly(Dor, Watson)</strong> has few short-term side effects but has a higher long-term failure rate.</li>\n<li><strong>Transoral Incisionless <span class=\"customMeta\" data-dictid=\"5ef90c9b94169277720333361d520e\">Fundoplication</span> (TIF): </strong>An <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> procedure performed through the mouth but may be less effective for severe GERD and not suitable for all patients.</li>\n<li><strong>Magnetic <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">Sphincter</span> Augmentation (LINX Device): </strong>Involves implanting a ring of magnetic beads around the lower oesophagal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> to enhance its function and prevent reflux.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following do not require instruments to examine?", "options": [{"label": "A", "text": "Acute anal fissure", "correct": true}, {"label": "B", "text": "Carcinoma rectum", "correct": false}, {"label": "C", "text": "Hemorrhoids", "correct": false}, {"label": "D", "text": "Rectal polyp", "correct": false}], "correct_answer": "A. Acute anal fissure", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rectal exam findings on external and internal inspection:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>External Inspection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Internal Inspection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anal fissures</li>\n<li>Anal fistula</li>\n<li>Genital warts</li>\n<li>External haemorrhoids</li>\n<li>Pilonidal sinus</li>\n<li>Skin disease (seborrhoeic eczema, skin cancer, natal <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> dermatitis)</li>\n<li>Skin tags</li>\n<li>Skin discoloration with Crohn's disease</li>\n<li>Rectal prolapse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Internal haemorrhoids</li>\n<li>Rectal carcinoma</li>\n<li>Rectal polyps</li>\n<li>Tenderness with <span class=\"customMeta\" data-dictid=\"bf8668fa0e16927771965fbed47263\">prostatitis</span> or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</li>\n<li>Malignant or <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions of the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> palpation</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the incision marked as B", "options": [{"label": "A", "text": "Gridiron incision", "correct": false}, {"label": "B", "text": "Lanz incision", "correct": true}, {"label": "C", "text": "Rutherford - Morison incision", "correct": false}, {"label": "D", "text": "Rockey-Davis incision", "correct": false}], "correct_answer": "B. Lanz incision", "question_images": ["https://image.prepladder.com/content/0u6r7dcuV0qKd3hIuKGA1746983253.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of Incisions used for appendicectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Name of the incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incision area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of incision</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>McBurney's incision</strong></p>\n<p>(A in the image)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Centered on McBurney's point, perpendicular to the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ASIS line</li>\n<li>Junction of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 1/3 from <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> &amp; <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 2/3 from ASIS</li>\n<li>McBurney's point corresponds to the base of the appendix</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Aka Grid iron <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / McArthur <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lanz incision</strong></p>\n<p>(B in the image)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placed transversely 2 cm below the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> on the line joining the midpoint of the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> to the midpoint of the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Cosmetically better incision</li>\n<li>Aka Modified McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / Rocky Davis <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <strong>(Option D ruled out)</strong> / Bikini <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> (good <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rutherford-Morrison incision</strong></p>\n<p>(C in the image)</p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extension of McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for retrocecal appendicitis.</li>\n<li>Upward &amp; laterally by cutting the conjoint tendon.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle cutting incision</li>\n<li>Preferred for retrocecal appendix</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about carcinoid tumours in the appendix is false?", "options": [{"label": "A", "text": "Size appears to be the best predictor of malignant behaviour and metastatic potential", "correct": false}, {"label": "B", "text": "Arise from Kulchitsky cells of the crypts of Leiberkuhn", "correct": false}, {"label": "C", "text": "Most common location is the base of the appendix", "correct": true}, {"label": "D", "text": "Most common tumor of the appendix", "correct": false}], "correct_answer": "C. Most common location is the base of the appendix", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Carcinoid tumor of the <span class=\"customMeta\" data-dictid=\"b790a83bb41692777181cc3c0232af\">appendix</span> (aka Argentaffinoma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n<p><strong>(Options A &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>They are <strong>neuroendocrine tumours</strong> that originate from the <strong>enterochromaffin cells</strong> (also known as<strong> Kulchitsky cells</strong>) of the <strong>crypts of Lieberkuhn</strong>.</li>\n<li>They are considered the most common tumours of the appendix.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MC Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tip of the appendix</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mostly discovered incidentally during surgery</p>\n<p>Larger tumours may cause <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, flushing, and diarrhoea due to hormone secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormone Secretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secretes <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> and other <span class=\"customMeta\" data-dictid=\"1059a0d9031692777201a8d8debd5e\">vasoactive</span> substances.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk of Metastasis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low for tumours &lt;2 cm</li>\n<li>Higher for tumours&gt;2 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmed by histopathological examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>&lt;2 cm</strong>: Appendectomy</li>\n<li><strong>&gt;2 cm</strong>: Right hemicolectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common type of gastric sarcoma:", "options": [{"label": "A", "text": "GIST", "correct": true}, {"label": "B", "text": "Liposarcoma", "correct": false}, {"label": "C", "text": "Leiomyosarcoma", "correct": false}, {"label": "D", "text": "Epithelioid sarcoma", "correct": false}], "correct_answer": "A. GIST", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gastrointestinal stromal tumour (GIST)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mutations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common-<strong> c-KIT/CD117</strong></li>\n<li>Others:\n\t\t\t\t<ul>\n<li>PDGFR- beta</li>\n<li><strong>S</strong>uccinate <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (SDH)- <strong>S</strong>mall baby( Pediatric GIST)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>KIT (c-kit) </strong>is a <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> <span class=\"customMeta\" data-dictid=\"b989cb3b0d1692777187dd7965b4d3\">encoding</span> a<strong> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> tyrosine kinase. </strong>Mutations result in constant <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of KIT signalling, driving tumour growth and survival.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common Locations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stomach:</strong> 60-70% of cases.</li>\n<li><strong>Small Intestine:</strong> 20-30%.</li>\n<li><strong>Other Areas:</strong> Colon, rectum, and <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> (less common).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> inhibitors <strong>- Imatinib</strong></li>\n<li>Surgical management</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What structures are contained within the anterior pararenal space? Head, neck, and body of the pancreas Adrenal gland, kidney, ureters Aorta, inferior vena cava Ascending and descending colon", "options": [{"label": "A", "text": "1,4", "correct": true}, {"label": "B", "text": "3,4", "correct": false}, {"label": "C", "text": "2,3", "correct": false}, {"label": "D", "text": "1,2", "correct": false}], "correct_answer": "A. 1,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5czx302KQ7xSRXKAfzaV1748160174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Retroperitoneal spaces</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"bcca994ca11692777194239a21b52c\">pararenal</span> space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It contains the<strong> head, neck, and body of the pancreas</strong> (the tail of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> is within the <span class=\"customMeta\" data-dictid=\"e244a577831692777199eecf7e9f47\">splenorenal</span> ligament), the <strong>ascending and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> colon, and the duodenum</strong> (except for the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> first segment).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Perirenal space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This includes the <strong>adrenal gland, kidney, ureters, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vessels. (Statement 2 ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"bcca994ca11692777194239a21b52c\">pararenal</span> space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is surrounded by the <strong>posterior leaf of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and muscles of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</strong>, contains no major organs and is composed primarily of fat, blood vessels, and lymphatics.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>There is also a fourth, less well-defined space known as the <strong>great vessel space</strong>. It lies <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the vertebral bodies and <span class=\"customMeta\" data-dictid=\"1ca45620ed1692777196a47f648338\">psoas</span> muscles and contains the aorta, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava, and surrounding fat. <strong>(Statement 3 ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Goran Mitreski and Tom Sutherland\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Retroperitoneal_spaces.png\" data-tags=\"\" height=\"2255\" src=\"https://image.prepladder.com/content/5czx302KQ7xSRXKAfzaV1748160174.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What electrolyte imbalance is commonly observed in patients with this postoperative condition, as depicted in the provided x-ray?", "options": [{"label": "A", "text": "Hypocalcemia", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": true}, {"label": "C", "text": "Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypercalcemia", "correct": false}], "correct_answer": "B. Hypokalemia", "question_images": ["https://image.prepladder.com/content/eDEVAAKbdfHXxtaqD7E21748160201.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Paralytic ileus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abdominal surgery.</li>\n<li>Uremia.</li>\n<li>Mesenteric ischemia.</li>\n<li>Retroperitoneal hematoma.</li>\n<li>Intra-abdominal sepsis.</li>\n<li>Dyselectrolytemia (e.g. hypokalemia)<strong> (Option B)</strong></li>\n<li>Drugs affecting intestinal motility:\n\t\t\t\t<ul>\n<li>Opiates.</li>\n<li>Antipsychotics.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abdominal distension.</li>\n<li>Abdominal discomfort.</li>\n<li><strong>Non-colicky pain.</strong></li>\n<li>Vomiting.</li>\n<li>Non-passage of <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> and flatus.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IOC: </strong>Abdominal X-ray.</p>\n<p><strong>Findings:</strong></p>\n<ul>\n<li>Dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n<li>Gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum.</li>\n<li>Multiple air-fluid levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Decompression: </strong>Nasogastric aspiration.</p>\n<p> </p>\n<p><strong>Diet: </strong>Restrict oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> until <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> sounds return or the patient starts passing faeces and flatus.</p>\n<p> </p>\n<p><strong>Treatment of Underlying Cause:</strong></p>\n<ul>\n<li>Correct dyselectrolytemia (e.g., hypokalemia).</li>\n<li>Discontinue medications affecting <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> (e.g., opiates).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with diffuse abdominal pain. He has a past history of peptic ulcer disease. Physical examination reveals rigidity. An X-ray of the abdomen is shown below. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Antibiotics and NPO (nothing by mouth)", "correct": false}, {"label": "B", "text": "Upper GI endoscopy", "correct": false}, {"label": "C", "text": "Urgent surgical exploration", "correct": true}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "C. Urgent surgical exploration", "question_images": ["https://image.prepladder.com/content/6Nsbdblg4DYZIDauULRo1747113713.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate presented with mild intermittent upper abdominal pain. On examination, the infant has a scaphoid abdomen and breath sounds are decreased on both sides. The X-ray is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Bochdalek hernia", "correct": true}, {"label": "B", "text": "Pneumonia", "correct": false}, {"label": "C", "text": "Gastric volvulus", "correct": false}, {"label": "D", "text": "Eventration of diaphragm", "correct": false}], "correct_answer": "A. Bochdalek hernia", "question_images": ["https://image.prepladder.com/content/7T7HmW0qKbJuhXMY9vgJ1747115903.png"], "explanation_images": ["https://image.prepladder.com/content/R9lnarz4wmeN8Bckla9w1747115954.png", "https://image.prepladder.com/content/pwC0h6eYHbzAqZTmAGc31748162916.png", "https://image.prepladder.com/content/5XLDRVy2ildL8MjQLL8I1748162934.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bochdalek hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is due to the failure of the <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the <span class=\"customMeta\" data-dictid=\"8f7c89df6e16927771951d19c26422\">pleuroperitoneal</span> canal, which leads to direct communication between the <span class=\"customMeta\" data-dictid=\"8067ea0c85169277719561c9591e9d\">pleura</span> and <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> on the<strong> left side.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colon, occasionally small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> or stomach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypoplasia (potentially bilateral)</li>\n<li>Decreased bronchial branch generation</li>\n<li>Extension of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> media beyond <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> bronchioles</li>\n<li>Decreased total lung mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Pulmonary hypoplasia</li>\n<li>Pulmonary hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Respiratory embarrassment</li>\n<li>Scaphoid abdomen</li>\n<li>Bowel sounds on the left side of the chest</li>\n<li>Mediastinal shift towards the right side</li>\n<li>Intestinal obstruction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a neonate who is brought to the hospital with complaints of forceful vomiting that is not accompanied by bile after feeding? The child appears lethargic and dehydrated, and abdominal examination shows visible movements of the stomach. A barium meal was conducted, and the image provided is shown below.", "options": [{"label": "A", "text": "Hirschsprung’s disease", "correct": false}, {"label": "B", "text": "Congenital hypertrophic pyloric stenosis", "correct": true}, {"label": "C", "text": "Jejunal atresia", "correct": false}, {"label": "D", "text": "Duodenal atresia", "correct": false}], "correct_answer": "B. Congenital hypertrophic pyloric stenosis", "question_images": ["https://image.prepladder.com/content/27CaXZTBGu9cUPn8z99i1747116174.png"], "explanation_images": ["https://image.prepladder.com/content/kfZkaOWcR6b7dPmtFAZY1747116203.png", "https://image.prepladder.com/content/heeBWIfoTh3AocNTBXEt1747116203.png", "https://image.prepladder.com/content/8AuSr5uK4hcc4UVVV2Hv1747116203.png", "https://image.prepladder.com/content/eM70tKpTGxKz3NQUkEta1747116203.png", "https://image.prepladder.com/content/yyvflF4B9R2yB3l0qJLT1747116203.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Congenital <span class=\"customMeta\" data-dictid=\"2cf4f27ae616927771895f410747ad\">hypertrophic pyloric stenosis</span> (CHPS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a condition involving <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> of the pyloric muscle, leading to <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants, typically between 2 and 6 weeks of age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> <strong>Projectile, non-bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> after feeds, starting around 2 to 6 weeks of age. </strong>\n<ul>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> leads to <strong>dehydration, <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> </strong>and <strong>hypochloremic <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> </strong>because the body loses <strong>hydrochloric acid (HCl)</strong> in the vomitus.</li>\n</ul>\n</li>\n<li><strong>Physical Examination: Visible <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> from left to right</strong> and a palpable<strong> “olive-shaped”</strong> mass in the epigastric region.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound (USG) </strong>is the Investigation of choice for CHPS, characterised by\n\t\t\t\t<ul>\n<li>Pyloric muscle <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of<strong> &gt; 3 mm </strong></li>\n<li>Pyloric length <strong>&gt; 14 mm </strong></li>\n<li>The pyloric channel appears elongated and thickened <strong>(10-14 mm)</strong></li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"570\" src=\"https://image.prepladder.com/content/kfZkaOWcR6b7dPmtFAZY1747116203.png\" width=\"568\"/></p>\n<ul>\n<li><strong>Contrast Studies (Upper GI Series): </strong>Less frequently used, demonstrating the classic <strong> ¸</strong> with a thin line of contrast through the<strong> elongated and narrowed pyloric channel and <span class=\"customMeta\" data-dictid=\"6cad6b72af16927771868f07a43773\">delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</span> without duodenal dilation. </strong></li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Adityagupta95, \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hypertrophic_pyloric_stenosis.png\" data-tags=\"\" height=\"598\" src=\"https://image.prepladder.com/content/heeBWIfoTh3AocNTBXEt1747116203.png\" width=\"470\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 5-year-old child with abdominal swelling, mild discomfort, no pain or vomiting, and a fluctuant soft swelling that moves freely in a plane perpendicular to the mesentery attachment, as seen in the outpatient department?", "options": [{"label": "A", "text": "Peritoneal cyst", "correct": false}, {"label": "B", "text": "Lipoma", "correct": false}, {"label": "C", "text": "Chylolymphatic cyst", "correct": true}, {"label": "D", "text": "Pseudocyst", "correct": false}], "correct_answer": "C. Chylolymphatic cyst", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below shows an image of the anus. What is the most likely diagnosis, and it occurs when one of your anus glands becomes clogged and infected? Pus and fluid accumulate in the anal gland, resulting in an excruciatingly painful abscess around your anus?", "options": [{"label": "A", "text": "Hemorrhoids", "correct": false}, {"label": "B", "text": "Pelvirectal abscess", "correct": false}, {"label": "C", "text": "Perianal abscess", "correct": true}, {"label": "D", "text": "Pilonidal sinus", "correct": false}], "correct_answer": "C. Perianal abscess", "question_images": ["https://image.prepladder.com/content/TT0ZUp7CPlKtqS0fi6k61748163177.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most probable diagnosis for a 38-year-old male patient who visited the surgery OPD with a history of occasional discharge of pus with a slight presence of blood from an external opening in the perianal region, despite multiple attempts at drainage? The examination of the perianal region is depicted below.", "options": [{"label": "A", "text": "Pilonidal sinus", "correct": false}, {"label": "B", "text": "Perianal abscess", "correct": false}, {"label": "C", "text": "Hemorrhoids", "correct": false}, {"label": "D", "text": "Fistula-in-ano", "correct": true}], "correct_answer": "D. Fistula-in-ano", "question_images": ["https://image.prepladder.com/content/20M6baMzU3BdU6CUaRfQ1748163195.png"], "explanation_images": ["https://image.prepladder.com/content/nPBAClMBDTtebExPR4iL1748163203.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fistula-in-ano</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.<strong> </strong></li>\n<li>Associated Conditions:\n\t\t\t\t<ul>\n<li>Crohn’s disease</li>\n<li>Tuberculosis</li>\n<li>Lymphogranuloma venereum</li>\n<li>Actinomycosis</li>\n<li>Rectal duplication</li>\n<li>Foreign bodies</li>\n<li>Malignancy (rare, can develop within a longstanding fistula)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</li>\n<li>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening (indicative of a rectal rather than an anal internal opening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parks classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 1</strong> - Inter- sphincteric (most common, 70%)</p>\n<p><strong>Type 2</strong> - Trans- sphincteric (25%)</p>\n<p><strong>Type 3</strong> - Supra- sphincteric (4%)</p>\n<p><strong>Type 4 </strong>- Extra- sphincteric (1%)</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kenneth Voon Kher Ti\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Parks-Classification-in-1976-4-main-types-with-its-sub-types-diagrams-obtained-from_fig1_355104986\" data-tags=\"\" height=\"684\" src=\"https://image.prepladder.com/content/nPBAClMBDTtebExPR4iL1748163203.png\" width=\"736\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant of 12 weeks presented with the following defect in the umbilical area. Identify the condition.", "options": [{"label": "A", "text": "Omphalocele", "correct": false}, {"label": "B", "text": "Gastroschisis", "correct": false}, {"label": "C", "text": "Umbilical hernia", "correct": false}, {"label": "D", "text": "Paraumbilical hernia", "correct": true}], "correct_answer": "D. Paraumbilical hernia", "question_images": ["https://image.prepladder.com/content/6HIJ7N8eAvKAg0aF1Y1j1748163304.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, after heavy drinking of alcohol presents with multiple episodes of vomiting and hematemesis. The most likely diagnosis is:", "options": [{"label": "A", "text": "Mallory-Weiss syndrome", "correct": true}, {"label": "B", "text": "Esophageal carcinoma", "correct": false}, {"label": "C", "text": "Achalasia cardia", "correct": false}, {"label": "D", "text": "Boerhaave's syndrome", "correct": false}], "correct_answer": "A. Mallory-Weiss syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mallory-Weiss syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is defined as mucosal lacerations in the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> at the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> (GE) <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> that are caused by forceful vomiting, retching, coughing, or straining.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It accounts for 10-15% of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> upper <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> haemorrhages.</li>\n<li>The greatest risk for massive haemorrhage is <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> patients with preexisting <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcoholic patients with intense <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> after <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> drinking.</li>\n<li>Forceful <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contractions against a closed cardia.</li>\n<li>Any patient with repeated episodes of emesis.</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> in <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The patient's history is crucial.</li>\n<li>It can be confirmed with endoscopy.</li>\n<li>Retroflexion manoeuvre during <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> is used to view the area below the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> junction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vomiting, hematemesis, upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, hypotension, tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely massive <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> associated with <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopic methods (multipolar electrocoagulation, <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> injection, band ligation), angiographic transarterial embolisation, rarely surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally good with appropriate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> treatment</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The treatment of choice for inguinal hernia in infants is:", "options": [{"label": "A", "text": "Herniotomy", "correct": true}, {"label": "B", "text": "Herniorrhaphy", "correct": false}, {"label": "C", "text": "TRUSS", "correct": false}, {"label": "D", "text": "Hernioplasty", "correct": false}], "correct_answer": "A. Herniotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are true about Crohn’s disease except", "options": [{"label": "A", "text": "Rectum is involved", "correct": true}, {"label": "B", "text": "Serpiginous ulcers are formed", "correct": false}, {"label": "C", "text": "Transmural involvement", "correct": false}, {"label": "D", "text": "Recurrence is more common", "correct": false}], "correct_answer": "A. Rectum is involved", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\"&gt;Rectum&lt;/span&gt; is involv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gall stone chemistry most commonly seen amongst the following is:", "options": [{"label": "A", "text": "Crystalline cholesterol monohydrate", "correct": true}, {"label": "B", "text": "Crystalline cholesterol dihydrate", "correct": false}, {"label": "C", "text": "Amorphous cholesterol dihydrate", "correct": false}, {"label": "D", "text": "Amorphous cholesterol monohydrate", "correct": false}], "correct_answer": "A. Crystalline cholesterol monohydrate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During an emergency laparotomy performed for a patient with intestinal obstruction, which organ would you initially observe to determine whether it is a case of small bowel or large bowel obstruction?", "options": [{"label": "A", "text": "Ileum", "correct": false}, {"label": "B", "text": "Caecum", "correct": true}, {"label": "C", "text": "Jejunum", "correct": false}, {"label": "D", "text": "Sigmoid colon", "correct": false}], "correct_answer": "B. Caecum", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of hernia is a funicular hernia ?", "options": [{"label": "A", "text": "Direct inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Umbilical hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of anorectal fistula ?", "options": [{"label": "A", "text": "Intersphincteric", "correct": true}, {"label": "B", "text": "Trans-sphincteric", "correct": false}, {"label": "C", "text": "Suprasphincteric", "correct": false}, {"label": "D", "text": "Extrasphincteric", "correct": false}], "correct_answer": "A. Intersphincteric", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pHmEzRFlgIAU13o0QphH1705036187.png"], "explanation": "<p>Correct Option A - Intersphincteric:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 1</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Intersphincteric</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 2</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Trans-sphincteric</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 3</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Suprasphincteric</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 4</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Extrasphincteric</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male had acute appendicitis 3 days ago and presented to the surgery department with abdominal pain and tenderness . Which of the following incisions would be appropriate for this condition?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": true}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "C. 3", "question_images": ["https://image.prepladder.com/content/Xrhh7cw7DtCQGTsi2xGi1685075679.png"], "explanation_images": [], "explanation": "<p>Correct Option C - 3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old alcoholic with a history of binge drinking presents with an episode of vomiting bright red blood . His vitals are stable. An endoscopy was performed, an image of which is given below; what is the probable diagnosis here?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": false}, {"label": "B", "text": "Boerhaave syndrome", "correct": false}, {"label": "C", "text": "Mallory Weiss Tear", "correct": true}, {"label": "D", "text": "Gastric ulcer perforation", "correct": false}], "correct_answer": "C. Mallory Weiss Tear", "question_images": ["https://image.prepladder.com/content/RzItqIRo5lfMLpJyv0XQ1712294590.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Mallory Weiss T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause of massive, sudden onset hematemesis in a 50-year-old patient with a history of chronic liver disease and chronic alcoholism, who has arrived at the emergency department?", "options": [{"label": "A", "text": "Mallory Weiss tear", "correct": false}, {"label": "B", "text": "Bleeding esophageal varices", "correct": true}, {"label": "C", "text": "Boerhaave’s syndrome", "correct": false}, {"label": "D", "text": "Perforated ulcer", "correct": false}], "correct_answer": "B. Bleeding esophageal varices", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Bleeding &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;esophageal&lt;/span&gt; v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-day old neonat e presents abdominal distension and bilious vomiting . Among the following, which is the most appropriate investigation to diagnose the condition?", "options": [{"label": "A", "text": "Barium swallow", "correct": false}, {"label": "B", "text": "Barium meal", "correct": false}, {"label": "C", "text": "Barium meal follow through", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": true}], "correct_answer": "D. CECT abdomen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - CECT\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the pathology in the given radiograph of a newborn .:", "options": [{"label": "A", "text": "Meningocele", "correct": false}, {"label": "B", "text": "Imperforate anus", "correct": true}, {"label": "C", "text": "Congenital megacolon", "correct": false}, {"label": "D", "text": "Pyloric stenosis", "correct": false}], "correct_answer": "B. Imperforate anus", "question_images": ["https://image.prepladder.com/content/4f2w53ZmoDS8DBPhpBOt1713356415.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Imperforate anu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best investigation to establish a diagnosis of GERD ?", "options": [{"label": "A", "text": "24 hours ambulatory pH monitoring", "correct": true}, {"label": "B", "text": "Upper GI endoscopy", "correct": false}, {"label": "C", "text": "CECT", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "A. 24 hours ambulatory pH monitoring", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 24 hours &lt;span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\"&gt;ambulatory&lt;/span&gt; pH monitoring\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old alcoholic and a chronic smoker presented with bouts of vomiting and stabbing pain in the epigastrium . He was binge drinking shortly before the symptoms started. He is febrile and tachycardic . The given findings were seen on bedside radiological imaging. Which among the following is a likely cause of this?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": false}, {"label": "B", "text": "Peptic ulcer perforation", "correct": true}, {"label": "C", "text": "Boerhaave syndrome", "correct": false}, {"label": "D", "text": "Mallory Weiss tear", "correct": false}], "correct_answer": "B. Peptic ulcer perforation", "question_images": ["https://image.prepladder.com/content/E1ZWnUmMRaZhbduTox1e1698123186.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Peptic &lt;span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\"&gt;ulcer&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common deficiency observed after gastric bypass /bariatric surgery ?", "options": [{"label": "A", "text": "Iron", "correct": true}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Zinc", "correct": false}, {"label": "D", "text": "Calcium", "correct": false}], "correct_answer": "A. Iron", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man underwent Roux-en-Y gastric bypass surgery for obesity . He now presents to his physician with complaints of dizziness, fatigue, and tremors 2 hours after the ingestion of a carbohydrate-rich meal . His symptoms occur mainly due to 1. Hypoglycemia 2. Small volume of food intake 3. High osmotic load of food 4. Increased release of insulin 5. Increased release of glucagon", "options": [{"label": "A", "text": "1, 2 and 5", "correct": false}, {"label": "B", "text": "1, 3 and 5", "correct": false}, {"label": "C", "text": "1 and 4", "correct": true}, {"label": "D", "text": "3 and 5", "correct": false}], "correct_answer": "C. 1 and 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 1 and 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young adult with gastric outlet obstruction presents with vomiting . Which of the following fluids is preferred in this patient for initial resuscitation ?", "options": [{"label": "A", "text": "Normal saline", "correct": true}, {"label": "B", "text": "Ringer lactate", "correct": false}, {"label": "C", "text": "5% dextrose in water", "correct": false}, {"label": "D", "text": "20% dextrose in water", "correct": false}], "correct_answer": "A. Normal saline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - N\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34 years old female with a history of alcohol intake was taking NSAIDs for abdominal pain . She developed severe pain in the whole abdomen . A radiograph is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Rupture of ectopic pregnancy", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": false}, {"label": "C", "text": "Perforated liver abscess", "correct": false}, {"label": "D", "text": "Hollow viscus perforation", "correct": true}], "correct_answer": "D. Hollow viscus perforation", "question_images": ["https://image.prepladder.com/content/0KDuSW28WiLjC3d2oBke1685101645.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Hollow &lt;span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\"&gt;viscus&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a patient who had a bronchospasm history, and was found to have a tumor in their ileum along with elevated levels of 5-hydroxy indoleacetic acid in their urine?", "options": [{"label": "A", "text": "Carcinoid tumor", "correct": true}, {"label": "B", "text": "Neuroblastoma", "correct": false}, {"label": "C", "text": "Leiomyoma", "correct": false}, {"label": "D", "text": "Chromaffinoma", "correct": false}], "correct_answer": "A. Carcinoid tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Carcinoid tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You are doing an emergency laparotomy for a case of intestinal obstruction . Which organ will you first visualize to know if this is a case of small bowel or large bowel obstruction ?", "options": [{"label": "A", "text": "Ileum", "correct": false}, {"label": "B", "text": "Caecum", "correct": true}, {"label": "C", "text": "Jejunum", "correct": false}, {"label": "D", "text": "Sigmoid colon", "correct": false}], "correct_answer": "B. Caecum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Caecu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient comes with active variceal bleeding . Which of the following is not done?", "options": [{"label": "A", "text": "Platelet transfusion", "correct": true}, {"label": "B", "text": "Arrange pRBC", "correct": false}, {"label": "C", "text": "IV Octreotide", "correct": false}, {"label": "D", "text": "Urgent Endoscopy", "correct": false}], "correct_answer": "A. Platelet transfusion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Platelet transfu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 28-year-old patient who is an alcoholic and presents to the hospital with symptoms of frequent vomiting, chest pain, fever, and hydropneumothorax?", "options": [{"label": "A", "text": "Boerrhave syndrome", "correct": true}, {"label": "B", "text": "Tension pneumothorax", "correct": false}, {"label": "C", "text": "PUD perforation", "correct": false}, {"label": "D", "text": "Mallory Weiss tear", "correct": false}], "correct_answer": "A. Boerrhave syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Fs7TgTN8qjDTiNp5M1zM1713356856.png"], "explanation": "<p>Correct Option A - Boerrhav\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the possible cause of sweating and diarrhea occurring within 20 minutes of eating in a patient who has undergone gastrectomy?", "options": [{"label": "A", "text": "Early dumping syndrome", "correct": true}, {"label": "B", "text": "Late dumbing syndrome", "correct": false}, {"label": "C", "text": "Hyperglycemia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": false}], "correct_answer": "A. Early dumping syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Early &lt;span class=\"customMeta\" data-dictid=\"ccf758bda61692777186aef3eee253\"&gt;Dumping&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"ccf758bda61692777186aef3eee253\">Dumping</span> Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late <span class=\"customMeta\" data-dictid=\"ccf758bda61692777186aef3eee253\">Dumping</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Time of occurrence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 30 minutes to 1 hour after a meal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 to 3 hours after a meal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathophysiology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of stomach contents into the small intestine, leading to a shift of fluid into the gut and rapid <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of glucose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reactive <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> due to excessive <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sweating, flushing, dizziness, lightheadedness, rapid heartbeat, palpitations, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cramps, bloating, nausea, vomiting, diarrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness, fatigue, lightheadedness, sweating, palpitations, confusion, hunger</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6 months child presented with the following presentation. What is the management protocol ?", "options": [{"label": "A", "text": "Indication of surgery if not resolved by 2 years", "correct": false}, {"label": "B", "text": "Surgery after 5 year", "correct": true}, {"label": "C", "text": "Immediate surgery", "correct": false}, {"label": "D", "text": "Hernioplasty", "correct": false}], "correct_answer": "B. Surgery after 5 year", "question_images": ["https://image.prepladder.com/content/0VMvsmOVfY59KFuL5EEi1713416992.png"], "explanation_images": [], "explanation": "<p>Correct Option B -Surgery after 5\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a risk factor for Esophageal carcinoma?", "options": [{"label": "A", "text": "GERD", "correct": false}, {"label": "B", "text": "Betel chewing", "correct": false}, {"label": "C", "text": "Oxalate food", "correct": true}, {"label": "D", "text": "Spicy food", "correct": false}], "correct_answer": "C. Oxalate food", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\"&gt;Oxalate&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>SCC (Squamous Cell Carcinoma)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Adenocarcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Alcohol</p>\n</li>\n<li>\n<p>Smoking</p>\n</li>\n<li>\n<p>Zenker’s diverticula</p>\n</li>\n<li>\n<p>Achalasia cardia</p>\n</li>\n<li>\n<p>Intake of</p>\n<ul>\n<li>\n<p>Nitrites</p>\n</li>\n<li>\n<p>Nitrates</p>\n</li>\n<li>\n<p>Nitrosamine</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Fungal toxins</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>GERD (gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease)</p>\n</li>\n<li>\n<p>High fat diet</p>\n</li>\n<li>\n<p><strong>Scleroderma:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"d9e29ece3c1692777186ce4d23d81b\">dysmotility</span> and smooth muscle <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> cause <span class=\"customMeta\" data-dictid=\"01e03927231692777188168edc7b35\">GERD</span> (gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease)</p>\n</li>\n<li>\n<p>Barret’s esophagus</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>HPV (human <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> virus) infections (16, 18, 31, 33)</p>\n</li>\n<li>\n<p>Plummer: Vinson syndrome</p>\n</li>\n<li>\n<p>Hot liquid ingestion</p>\n</li>\n<li>\n<p>Tylosis <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">Palmaris</span> &amp; Plantaris</p>\n</li>\n<li>\n<p>Deficiency of</p>\n<ul>\n<li>\n<p><strong>MO</strong> -<strong>M</strong>olybdenum</p>\n</li>\n<li>\n<p><strong>Z -Z</strong>inc</p>\n</li>\n<li>\n<p><strong>A </strong>- Vitamin-<strong>A</strong></p>\n</li>\n</ul>\n</li>\n<li>\n<p>Bulimia nervosa</p>\n</li>\n</ul>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Alvarado score of 2 is given for:", "options": [{"label": "A", "text": "Nausea", "correct": false}, {"label": "B", "text": "Temperature", "correct": false}, {"label": "C", "text": "Tenderness in right lower quadrant", "correct": true}, {"label": "D", "text": "Migratory pain", "correct": false}], "correct_answer": "C. Tenderness in right lower quadrant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Tenderness in right lower qu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alvarado Score aka MANTRELS Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MANTREL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Migratory pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Anorexia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Nausea, Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Rebound tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Elevated Temperature</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Leukocytosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Shift to Left</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Score of 9-10</strong>: Diagnosis is certain</p>\n</li>\n<li>\n<p><strong>Score of 7-8</strong>: High likely <span class=\"customMeta\" data-dictid=\"b64d7fd68c1692777189e1bae32157\">hood</span> of diagnosis</p>\n</li>\n<li>\n<p><strong>Score of 5-6</strong>: Equivocal (most dangerous)</p>\n<ul>\n<li>\n<p>CECT is indicated in cases of Equivocal MANTREL score findings to confirm the diagnosis.</p>\n</li>\n</ul>\n</li>\n<li>\n<p><strong>Score of 1-4</strong>: Negative for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "20 year old female previously diagnosed with Adenocarcinoma of the stomach , on examination following image was seen . What is the probable diagnosis ?", "options": [{"label": "A", "text": "Virchow’s node", "correct": false}, {"label": "B", "text": "Irish node", "correct": false}, {"label": "C", "text": "Sister mary joseph nodule", "correct": true}, {"label": "D", "text": "Infected umbilical hernia", "correct": false}], "correct_answer": "C. Sister mary joseph nodule", "question_images": ["https://image.prepladder.com/content/uh9selo4r6HwquBpWzpu1713417050.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Sister mary joseph nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the location of Killian's dehiscence , which causes Zenker's diverticulum , in a 40-year-old male presenting with dysphagia, regurgitation, and a foul-smelling mouth , and diagnosed after further evaluation in the emergency department?", "options": [{"label": "A", "text": "Above superior constrictor", "correct": false}, {"label": "B", "text": "Between inferior constrictor", "correct": true}, {"label": "C", "text": "Below the cricopharyngeal muscle", "correct": false}, {"label": "D", "text": "Below the upper 1/3 rd of the smooth muscle of the esophagus", "correct": false}], "correct_answer": "B. Between inferior constrictor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Between &lt;span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\"&gt;inferior&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are features of Zollinger-Ellison syndrome except:", "options": [{"label": "A", "text": "Intractable peptic ulcers", "correct": false}, {"label": "B", "text": "Severe diarrhea", "correct": false}, {"label": "C", "text": "Arise from beta cell tumors of the pancreas", "correct": true}, {"label": "D", "text": "Very high acid output", "correct": false}], "correct_answer": "C. Arise from beta cell tumors of the pancreas", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Arise from &lt;span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\"&gt;beta&lt;/span&gt; cell tumors of th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common type of intussusception :", "options": [{"label": "A", "text": "Colocolic", "correct": false}, {"label": "B", "text": "Ileoileal", "correct": false}, {"label": "C", "text": "Ileocolic", "correct": true}, {"label": "D", "text": "Ileal", "correct": false}], "correct_answer": "C. Ileocolic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Ileocolic: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Serum acid phosphate is raised in:", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Prostatic carcinoma", "correct": true}, {"label": "C", "text": "Paget's disease", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "B. Prostatic carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dohlman's procedure is for:", "options": [{"label": "A", "text": "Meckel's diverticulum", "correct": false}, {"label": "B", "text": "Zenker's diverticulum", "correct": true}, {"label": "C", "text": "Bochadlek hernia", "correct": false}, {"label": "D", "text": "Menetrier's disease", "correct": false}], "correct_answer": "B. Zenker's diverticulum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Zenker's diverticulu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding rectal carcinoma ?", "options": [{"label": "A", "text": "Hartmann's operation is done in elderly debilitated patients", "correct": false}, {"label": "B", "text": "Adenocarcinoma is a rare variant of rectal carcinoma", "correct": true}, {"label": "C", "text": "Early morning spurious diarrhoea and tenesmus can occur", "correct": false}, {"label": "D", "text": "Growth confined to the rectal mucosa is stage A of modified Duke's staging", "correct": false}], "correct_answer": "B. Adenocarcinoma is a rare variant of rectal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Adenocarcinoma is a rare &lt;span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\"&gt;variant&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A gasless abdomen is seen in?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Intussusception", "correct": false}, {"label": "C", "text": "Acute pancreatitis", "correct": true}, {"label": "D", "text": "Crohn's disease", "correct": false}], "correct_answer": "C. Acute pancreatitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Acu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the presence of serpiginous ulcers during esophageal endoscopy in a patient indicate in terms of diagnosis?", "options": [{"label": "A", "text": "CMV esophagitis", "correct": true}, {"label": "B", "text": "Candida esophagitis", "correct": false}, {"label": "C", "text": "Herpetic esophagitis", "correct": false}, {"label": "D", "text": "Radiation esophagitis", "correct": false}], "correct_answer": "A. CMV esophagitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - CMV esophag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of this triangle ?", "options": [{"label": "A", "text": "Gastrinoma triangle", "correct": true}, {"label": "B", "text": "Calot’s triangle", "correct": false}, {"label": "C", "text": "Doom’s triangle", "correct": false}, {"label": "D", "text": "Cholecystohepatic triangle", "correct": false}], "correct_answer": "A. Gastrinoma triangle", "question_images": ["https://image.prepladder.com/content/uWiS9EbIT6rApRYvnzMv1713425504.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5cdc49fa8b1692777188e3f26ac676\"&gt;Gastrinoma&lt;/span&gt; triang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the OPD, a 35-year-old male presented with concerns of passing dark-colored stools . Following an endoscopy, the patient was diagnosed with an upper gastrointestinal (GI) bleed. Which anatomical structure serves as a distinguishing point to differentiate it from a lower GI bleed?", "options": [{"label": "A", "text": "Ampulla of Vater", "correct": false}, {"label": "B", "text": "Ligament of Treitz", "correct": true}, {"label": "C", "text": "Superior duodenal flexure", "correct": false}, {"label": "D", "text": "IIeocaecal junction", "correct": false}], "correct_answer": "B. Ligament of Treitz", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ligament of Treitz:</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ The Ligament of Treitz, also known as the suspensory muscle of the duodenum, is a fibrous band located at the junction between the duodenum (the first part of the small intestine) and the jejunum (the second part of the small intestine).</li><li>↳ This anatomical landmark serves as a useful reference point for distinguishing between upper and lower GI bleeding.</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Option A - Ampulla of Vater: The Ampulla of Vater is the site where the common bile duct and the pancreatic duct join and enter the duodenum.</li><li>↳ Option A - Ampulla of Vater:</li><li>↳ Option C - Superior duodenal flexure: The superior duodenal flexure refers to the curved segment of the duodenum, where it transitions from the descending part to the horizontal part.</li><li>↳ Option C - Superior duodenal flexure:</li><li>↳ Option D - Ileocecal junction: The ileocecal junction is the point where the small intestine (ileum) connects to the large intestine (cecum).</li><li>↳ Option D - Ileocecal junction:</li></u\n<p><strong>References:</strong></p>\n<ul><li>↳ It is a fibrous band connecting the fourth part of the duodenum to the diaphragm, situated at the level of the duodenojejunal flexure.</li><li>↳ Used to differentiate between the upper and lower gastrointestinal tract, marking the transition between the proximal (upper) small intestine (duodenum) and the distal (lower) small intestine (jejunum).</li><li>↳ Important in diagnosing and classifying gastrointestinal bleeding. It helps differentiate upper GI bleeding (above the Ligament of Treitz) from lower GI bleeding (below it).</li><li>↳ A crucial landmark in various gastrointestinal surgeries, including gastric bypass and small intestine resection. Surgeons use it as a reference point to identify the duodenojejunal junction and plan interventions accordingly.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An abdominal mass in a patient with congenital hypertrophic pyloric stenosis is best seen _________:", "options": [{"label": "A", "text": "During feeding", "correct": true}, {"label": "B", "text": "Soon after birth", "correct": false}, {"label": "C", "text": "During palpation, over the left hypochondirum", "correct": false}, {"label": "D", "text": "During palpation, over the epigastrium", "correct": false}], "correct_answer": "A. During feeding", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - During feeding\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate statement regarding Crohn's disease?", "options": [{"label": "A", "text": "For effective treatment of a Crohn’s mass, only antibiotics are prescribed", "correct": false}, {"label": "B", "text": "Symptomatic relapse after surgery is not related to the presence of disease during resection", "correct": true}, {"label": "C", "text": "The proximal caecum is most commonly involved in Crohn’s disease", "correct": false}, {"label": "D", "text": "On endoscopic examination continuous lesions are visualised, which are diagnostic of Crohn’s disease", "correct": false}], "correct_answer": "B. Symptomatic relapse after surgery is not related to the presence of disease during resection", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Symptomatic &lt;span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\"&gt;relapse&lt;/span&gt; after surgery is not related to the presence of disease during\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the earliest indication of Crohn's disease among the options provided?", "options": [{"label": "A", "text": "Cobblestone appearance", "correct": false}, {"label": "B", "text": "Deep fissured ulcers", "correct": false}, {"label": "C", "text": "Rose-thorn appearance", "correct": false}, {"label": "D", "text": "Aphthous ulcers", "correct": true}], "correct_answer": "D. Aphthous ulcers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Aphthous u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Heller’s operation i s done for _______:", "options": [{"label": "A", "text": "Achalasia cardia", "correct": true}, {"label": "B", "text": "Carcinoma esophagus", "correct": false}, {"label": "C", "text": "Esophageal stricture", "correct": false}, {"label": "D", "text": "Hypertrophic pyloric stenosis", "correct": false}], "correct_answer": "A. Achalasia cardia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Barrett's esophagus is incorrect?", "options": [{"label": "A", "text": "It is the intestinal metaplasia of esophagus", "correct": false}, {"label": "B", "text": "Mucus secreting foveolar cells are characteristic", "correct": true}, {"label": "C", "text": "Alician blue is used in the staining of biopsy specimen", "correct": false}, {"label": "D", "text": "Adenocarcinoma of O-G junction is a complication", "correct": false}], "correct_answer": "B. Mucus secreting foveolar cells are characteristic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Mucus-secreting foveolar cells are ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common immediate complication of splenectomy:", "options": [{"label": "A", "text": "Hemorrhage", "correct": true}, {"label": "B", "text": "Fistula", "correct": false}, {"label": "C", "text": "Bleeding from gastric mucosa", "correct": false}, {"label": "D", "text": "Pancreatitis", "correct": false}], "correct_answer": "A. Hemorrhage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hemorrhag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child is brought with a high fever with rigors for 5 days with pain in the right hypochondrium . On examination, the patient is anicteric, and tenderness is noted in the right upper quadrant. What is the best investigation for this case?", "options": [{"label": "A", "text": "USG", "correct": false}, {"label": "B", "text": "Serology", "correct": true}, {"label": "C", "text": "SGOT/LFT", "correct": false}, {"label": "D", "text": "CECT", "correct": false}], "correct_answer": "B. Serology", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Serolog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective treatment approach for anal canal carcinoma?", "options": [{"label": "A", "text": "Chemoradiation", "correct": true}, {"label": "B", "text": "Surgery", "correct": false}, {"label": "C", "text": "Radiation Therapy", "correct": false}, {"label": "D", "text": "Chemotherapy", "correct": false}], "correct_answer": "A. Chemoradiation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female presented to the OPD with complaints of abdominal pain, diarrhea, and weight loss. On further evaluation, the patient was found to have multiple strictures of small bowel with interspersed areas of normal mucosa in between . Which of the following is false regarding the given condition?", "options": [{"label": "A", "text": "No recurrence after surgery", "correct": true}, {"label": "B", "text": "Aphthous ulcer", "correct": false}, {"label": "C", "text": "Skip lesions", "correct": false}, {"label": "D", "text": "Fistula formation", "correct": false}], "correct_answer": "A. No recurrence after surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - No &lt;span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\"&gt;recurrence&lt;/span&gt; after surg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the urgent indication for performing laparotomy in a 30-year-old man who presents with right iliac fossa pain lasting for four days , as depicted in the provided USG image?", "options": [{"label": "A", "text": "Rising pulse rate", "correct": false}, {"label": "B", "text": "Increasing abdominal pain", "correct": false}, {"label": "C", "text": "Increase in the size of mass", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": ["https://image.prepladder.com/content/KTKFgQdueEAaUCinRNp11713856913.png"], "explanation_images": [], "explanation": "<p>Correct Option D - All of the abov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Provide your opinion on the diagnosis based on a radiographic image displayed of a 65-year-old male experiencing acute abdominal pain.", "options": [{"label": "A", "text": "Ileocolic intussusception", "correct": false}, {"label": "B", "text": "Sigmoid volvulus", "correct": false}, {"label": "C", "text": "Toxic megacolon", "correct": false}, {"label": "D", "text": "Colocolic intussusception", "correct": true}], "correct_answer": "D. Colocolic intussusception", "question_images": ["https://image.prepladder.com/content/uw031wA6f0vYg87hYUFT1714481869.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Colocolic intussu\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Free air under the diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air is visualized under the diaphragm, indicating air escaping into the peritoneal cavity.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perforation of a <span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\">viscus</span> (e.g., <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> or duodenal ulcer)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thumbprinting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thickened mucosal folds with a \"thumbprint\" appearance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ischemic colitis, <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corkscrew appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tortuous and dilated appearance of the esophagus.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> spasm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Double bubble sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two air-filled bubbles are seen in the abdomen, representing dilated stomach and duodenum.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Duodenal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> or <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> in infants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thumb sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> with a thumb-like appearance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epiglottitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man visits the outpatient department with concerns of pain in the lower abdomen and rectal bleeding . After conducting additional tests, it is found that the patient has several shallow ulcers in the rectum that extend upwards to involve the entire colon . Upon examination of the tissue samples, it is discovered that only the mucosa and submucosa are affected. Which of the following complications associated with the aforementioned conditions is not harmful ?", "options": [{"label": "A", "text": "Toxic megacolon", "correct": false}, {"label": "B", "text": "Colonic polyp", "correct": true}, {"label": "C", "text": "Colonic obstruction", "correct": false}, {"label": "D", "text": "Massive colonic bleeding", "correct": false}], "correct_answer": "B. Colonic polyp", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Colonic polyp: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a boundary of the triangle of doom ?", "options": [{"label": "A", "text": "Vas deferens", "correct": false}, {"label": "B", "text": "Peritoneal Fold", "correct": false}, {"label": "C", "text": "Iliopubic tract", "correct": true}, {"label": "D", "text": "Spermatic vessels", "correct": false}], "correct_answer": "C. Iliopubic tract", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/D1WPZVCbhxXPAY2OFNtd1714479989.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e0b3e69ab9169277718997e696a3ab\"&gt;Iliopubic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old child presented with umbilical discharge . The abdominal examination was normal except for the finding below. The next step of management is?", "options": [{"label": "A", "text": "MRI Abdomen", "correct": false}, {"label": "B", "text": "USG Abdomen", "correct": true}, {"label": "C", "text": "CECT", "correct": false}, {"label": "D", "text": "Exploratory laparotomy", "correct": false}], "correct_answer": "B. USG Abdomen", "question_images": ["https://image.prepladder.com/content/dSdl8RYBBJIJxl0cwa9J1698056410.png"], "explanation_images": [], "explanation": "<p>Correct Option B - USG A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-day-old neonate presented with recurrent bilious vomiting . An X-ray the erect abdomen is given below. What is the next best step in managing this condition?", "options": [{"label": "A", "text": "CT abdomen", "correct": false}, {"label": "B", "text": "Gastrograffin follow-through", "correct": true}, {"label": "C", "text": "USG abdomen", "correct": false}, {"label": "D", "text": "Explorative laparotomy", "correct": false}], "correct_answer": "B. Gastrograffin follow-through", "question_images": ["https://image.prepladder.com/content/n39n6gZA7SEomhz3p8B41714480374.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Gastrograffin follow-through\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are true about intestinal transplantation except?", "options": [{"label": "A", "text": "Most of the grafts are multi-visceral grafts", "correct": true}, {"label": "B", "text": "It is not widely used due to vigorous rejection reactions", "correct": false}, {"label": "C", "text": "The most dangerous complication is sepsis", "correct": false}, {"label": "D", "text": "The most common indication is the ischemia", "correct": false}], "correct_answer": "A. Most of the grafts are multi-visceral grafts", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Most of the grafts are multi-visceral g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding superior mesenteric artery syndrome is false ?", "options": [{"label": "A", "text": "Third part of the duodenum is compressed", "correct": false}, {"label": "B", "text": "Angle between SMA and aorta is more than 70 degrees", "correct": true}, {"label": "C", "text": "Surgical management is by duodenojejunostomy", "correct": false}, {"label": "D", "text": "Also known as Wilkie's Syndrome", "correct": false}], "correct_answer": "B. Angle between SMA and aorta is more than 70 degrees", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Angle between SMA and &lt;span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\"&gt;aorta&lt;/span&gt; is more than 70 deg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 215 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 1.5-month-old male infant presents to the outpatient department with vomiting after feeding and failure to thrive . On examination, a firm, olive-shaped mass is palpated in the upper abdomen . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subacute Intestinal Obstruction", "correct": false}, {"label": "B", "text": "Pyloric Stenosis", "correct": true}, {"label": "C", "text": "GERD", "correct": false}, {"label": "D", "text": "Esophageal Atresia", "correct": false}], "correct_answer": "B. Pyloric Stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UIu3Uu2ja3gXkt5yywRZ1741075174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:421px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-6 weeks of life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Projectile, non-bilious vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Exam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Olive-shaped mass in epigastrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Pyloric muscle hypertrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ramstedt's pyloromyotomy</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic male patient diagnosed with hollow viscus perforation is taken up for laparotomy. Intraoperatively, a 2 cm perforation is seen in the duodenal region, as shown below. How can this patient be managed?", "options": [{"label": "A", "text": "Primary closure of the defect", "correct": false}, {"label": "B", "text": "Omental pedicle repair", "correct": true}, {"label": "C", "text": "Billroth I", "correct": false}, {"label": "D", "text": "Billroth II", "correct": false}], "correct_answer": "B. Omental pedicle repair", "question_images": ["https://image.prepladder.com/notes/iqBrkl6EwIaAn3tKwCgC1747645280.png"], "explanation_images": ["https://image.prepladder.com/content/rzg44LUr0jDvayCnCAh01747298076.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is/are complications associated with GERD? Asthma Laryngitis Pulmonary Fibrosis Chronic cough", "options": [{"label": "A", "text": "1,2", "correct": false}, {"label": "B", "text": "1,2,4", "correct": false}, {"label": "C", "text": "1,2,3", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": true}], "correct_answer": "D. 1,2,3,4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 1, 2, 3, 4\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Erosive esophagitis</li>\n<li>Esophageal stricture</li>\n<li>Barrett’s esophagus</li>\n<li>Esophageal cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extraesophageal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ENT complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Globus sensation</li>\n<li>Pharyngitis</li>\n<li>Sinusitis</li>\n<li>Otitis</li>\n<li>Laryngitis</li>\n<li>Dental erosions</li>\n<li>Laryngeal cancer</li>\n<li>Vocal cord granulomas</li>\n<li>Subglottic stenosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic cough</li>\n<li>Asthma</li>\n<li>Chronic bronchitis</li>\n<li>Pulmonary fibrosis</li>\n<li>Aspiration pneumonia</li>\n<li>Sleep apnea</li>\n<li>Non <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chest pain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a layer of esophagus?", "options": [{"label": "A", "text": "Mucosa", "correct": false}, {"label": "B", "text": "Submucosa", "correct": false}, {"label": "C", "text": "Serosa", "correct": true}, {"label": "D", "text": "Muscularis", "correct": false}], "correct_answer": "C. Serosa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following gene mutations are involved in carcinoma of the colon?", "options": [{"label": "A", "text": "APC, BRCA, k-ras", "correct": false}, {"label": "B", "text": "APC, k-ras, p53", "correct": true}, {"label": "C", "text": "MYh, K-RAS, APC", "correct": false}, {"label": "D", "text": "MYH, p53, DCC", "correct": false}], "correct_answer": "B. APC, k-ras, p53", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v2LXCinJ9IHT6vRt5dOK1745476398.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Other gene mutations associated with <span class=\"customMeta\" data-dictid=\"362992dbb11692777180f9017fc04d\">adenocarcinoma</span> colon</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Function/ association </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BRAF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common; involved in <span class=\"customMeta\" data-dictid=\"b47bc310681692777191d57afcc413\">MAPK</span> pathway</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TGFBR2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common; part of the TGF-β signalling pathway</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MYC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common; involved in cell proliferation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MLH1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DNA <span class=\"customMeta\" data-dictid=\"d949802d90169277719238da3d8f63\">mismatch repair</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> leads to MSI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BAX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common pro-apoptotic protein</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mandatory exploration is required in the injuries. Which zones of retroperitoneum are required?", "options": [{"label": "A", "text": "1", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "1 &amp;amp; 3", "correct": false}], "correct_answer": "A. 1", "question_images": ["https://image.prepladder.com/content/BtrUh1JnQzwqZHIzi0YH1748160116.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Zones of retroperitoneum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pelvic</p>\n<p>(retroperitoneal zone of the pelvis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structures involve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> &amp; its <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> branches</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> &amp; its <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tributaries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliac vessels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p><strong>(Other options ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exploration with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> &amp; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> control</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> (renal in origin) - managed nonoperatively (angioembolization)</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> injury present - exploration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> is exceptionally difficult to control.</li>\n<li>Usually, it should not be opened. It is managed by packing/angioembolisation.</li>\n<li>Explored only if there is expanding or <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> or <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> injury present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Heller's operation is done for____?", "options": [{"label": "A", "text": "Achalasia cardia", "correct": true}, {"label": "B", "text": "Carcinoma esophagus", "correct": false}, {"label": "C", "text": "Esophageal stricture", "correct": false}, {"label": "D", "text": "Hypertrophic pyloric stenosis", "correct": false}], "correct_answer": "A. Achalasia cardia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 17 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 28 y/o female presents with a history of chronic constipation, rectal pain, and bleeding. On examination, an ulcer is found on the anterior wall of the rectum, 7 cm from the anal verge. Proctography reveals rectal intussusception. Which is the most appropriate treatment for this patient's condition?", "options": [{"label": "A", "text": "STARR Procedure", "correct": true}, {"label": "B", "text": "Abdominal Rectopexy", "correct": false}, {"label": "C", "text": "Histology", "correct": false}, {"label": "D", "text": "Colostomy", "correct": false}], "correct_answer": "A. STARR Procedure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qPUJdVoGbQ7xZd18Cyce1748962874.mp3", "video": ""}, {"text": "A 55 y/o male presents with rectal bleeding and pain during defecation. O/E, a firm mass is palpable in the anal canal. A biopsy confirms carcinoma of the anal canal. Imaging shows no distant metastasis, but inguinal nodes are enlarged. Which of the following is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Abdominoperineal Resection (APR) with Colostomy", "correct": false}, {"label": "B", "text": "Chemoradiation", "correct": true}, {"label": "C", "text": "Radiotherapy alone", "correct": false}, {"label": "D", "text": "Neoadjuvant Chemotherapy followed by surgery", "correct": false}], "correct_answer": "B. Chemoradiation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ExuWsGCkjG9buzCB7NeW1748962669.mp3", "video": ""}, {"text": "A 60 y/o patient is diagnosed with anal canal cancer. A tumour of size 3cm invades through the muscularis propria into the perirectal tissue, involving 4-6 regional lymph nodes without distant metastasis. Which of the following stages correctly describes this condition?", "options": [{"label": "A", "text": "Stage I (T1-T2, N0, M0)", "correct": false}, {"label": "B", "text": "Stage II (T1-T2, N1, M0)", "correct": false}, {"label": "C", "text": "Stage III (T1-T4, N2, M0)", "correct": true}, {"label": "D", "text": "Stage IV (T1-T4, N1-N3, M1)", "correct": false}], "correct_answer": "C. Stage III (T1-T4, N2, M0)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:492px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No evidence of a primary tumour</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (localized)</p>\n<p>Aka Bowens disease</p>\n<p>Anal <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> neoplasia(AIN) <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> - III</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤ 2cm,</p>\n<p>Invades the submucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt;2 cm but &lt;5 cm,</p>\n<p>Invades the <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> propria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor&gt;5 cm,</p>\n<p>Invades the subserosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour of any size that invades adjacent organs or structures eg. Vagina, urethra, Bladder</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:496px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of 1-3 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of 4-6 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of 7 or more regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:498px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> present</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:499px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis, N0, M0 (carcinoma in situ)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1-T2, N0, M0 (localized)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1-T2, N1, M0 (locally advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1-T4, N2-N3, M0 (late locally advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1-T4, N1-N3, M1 (metastatic)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dpoC857kD2YUOHD8OsMW1748961072.mp3", "video": ""}, {"text": "A 58 y/o woman presents with anal pain, bleeding during bowel movements, and the presence of a palpable mass. She has a history of multiple sexual partners and was recently diagnosed with human papillomavirus (HPV) infection. Which of the following risk factors is most strongly associated with the development of anal canal cancer in this patient?", "options": [{"label": "A", "text": "HPV infection leads to anal condylomata.", "correct": true}, {"label": "B", "text": "Immunosuppression due to a recent organ transplant.", "correct": false}, {"label": "C", "text": "History of vulvar intraepithelial neoplasia (VIN).", "correct": false}, {"label": "D", "text": "Chronic constipation resulting in haemorrhoids.", "correct": false}], "correct_answer": "A. HPV infection leads to anal condylomata.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Human <span class=\"customMeta\" data-dictid=\"70ae0d8a1f1692777194515e8836a4\">Papillomavirus</span> (HPV) Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strongly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer, particularly high-risk subtypes (16, 18, 31, 33)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Anal <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">Intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> (AIN)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A precancerous condition significantly increases the risk of <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer, especially from AIN II or III.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunosuppression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Individuals with weakened immune systems (e.g., HIV-positive, transplant recipients) have a higher risk due to impaired <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> response and AIN development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sexual Practices</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anal <span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\">intercourse</span> increases <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> transmission risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>History of Other <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A history of vulvar <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> (VIN) or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> (CIN) raises the risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Extensive Anogenital Condylomata</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The presence of extensive anal warts <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> infection elevates the risk of anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/abLPPXpWsaXAJGdRr0111748960842.mp3", "video": ""}, {"text": ".A 78-year-old woman with a history of chronic constipation and faecal incontinence presents with a complaint of a mass that protrudes circumferentially from her anus, which she can manually reduce. She also reports occasional bleeding and difficulty with bowel movements. Which of the following is the most appropriate management for this patient's rectal prolapse?", "options": [{"label": "A", "text": "Perineal rectopexy", "correct": true}, {"label": "B", "text": "Rubber band ligation", "correct": false}, {"label": "C", "text": "Abdominal rectopexy", "correct": false}, {"label": "D", "text": "Infrared photocoagulation", "correct": false}], "correct_answer": "A. Perineal rectopexy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:584px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Abdominal Rectopexy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Perineal Rectopexy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic or <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> rectopexy-anterior/ posterior- <strong>Well's, Ripstein</strong></li>\n<li>Suture rectopexy- <strong>Lahaut</strong></li>\n<li>Anterior Resection</li>\n<li>Resection Rectopexy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal sleeve <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (<strong>Delrome's</strong>)</li>\n<li>Perineal recto <span class=\"customMeta\" data-dictid=\"c571bd042816927771984a81e88895\">sigmoidectomy</span> (<strong>Altemeier's</strong>)</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> of <strong>Lockhardt-Mummery </strong></li>\n<li><strong>Mickulicz Miles</strong> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> <span class=\"customMeta\" data-dictid=\"ebf9c40d2b16927772009a937efb25\">transanal</span> recto sigmoidectomy</li>\n<li>Anal encircling (<strong>Thiersch</strong>)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fixation of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> provides adequate tension to prevent recurrence.</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> options (laparoscopic or robotic) offer benefits in pain control, hospital stay, and recovery time</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lower <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality, suitable for elderly or medically unfit patients.</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires extensive <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> and fixation, which may have higher <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> (10%-33%).</li>\n<li>Risk of mesh-related complications such as erosion, infection, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, and migration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approaches</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ugw8og7N0jwflPTdo8hO1748951336.mp3", "video": ""}, {"text": "A 58 y/o man presents with bright red blood in his stool, tenesmus, and intermittent abdominal pain for one month. A digital rectal exam reveals a hard mass 5 cm from the anal verge. Rigid sigmoidoscopy confirms a neoplasm. What is the next step to evaluate the extent of his disease?", "options": [{"label": "A", "text": "Perform a CT scan of the abdomen and pelvis.", "correct": true}, {"label": "B", "text": "Schedule a colonoscopy.", "correct": false}, {"label": "C", "text": "Obtain a biopsy of the rectal mass.", "correct": false}, {"label": "D", "text": "Surgical intervention", "correct": false}], "correct_answer": "A. Perform a CT scan of the abdomen and pelvis.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/btf8afuXGzJtA0TAdNYk1748960277.mp3", "video": ""}, {"text": "A 35-year-old woman experiencing severe pain during bowel movements, bright red blood on toilet paper, and chronic anal fissures has not improved with conservative treatment and is being referred for surgery. Which surgical procedure is aimed at reducing anal sphincter tone to promote healing of the fissure while maintaining continence?", "options": [{"label": "A", "text": "Fissurectomy", "correct": false}, {"label": "B", "text": "Lateral Internal Sphincterotomy", "correct": true}, {"label": "C", "text": "Anal Advancement Flap", "correct": false}, {"label": "D", "text": "Botulinum toxin injection", "correct": false}], "correct_answer": "B. Lateral Internal Sphincterotomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle and Dietary Modifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aim: To soften stools and reduce pain</p>\n<ul>\n<li>Increase fiber intake</li>\n<li>Adequate fluid intake</li>\n<li>Warm <strong>Sitz baths</strong> to relax the anal sphincter.</li>\n<li>Topical anaesthetics.</li>\n<li><strong>Anorectal biofeedback:</strong> Helps patients learn to relax the anal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> and improve <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> control.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Topical medications:</strong></li>\n</ol>\n<ul>\n<li>Glyceryl <span class=\"customMeta\" data-dictid=\"cfb872d8e416927772000ca0743ef2\">trinitrate</span> (GTN) <span class=\"customMeta\" data-dictid=\"25ee86538e1692777194ef5ba9e4f1\">ointment</span> (0.2%)<strong>:</strong> Applied 2-3 times daily; a <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> donor that promotes <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> but may cause headaches.</li>\n<li>Diltiazem (2%)<strong>:</strong> Applied twice daily; a <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> that induces <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> with fewer side effects compared to GTN.</li>\n</ul>\n<ol>\n<li><strong>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections:</strong> 10-100 units <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> into the internal anal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> to reduce pressure and allow <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> release.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral Internal Sphincterotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Divides a small portion of the internal anal sphincter.</p>\n<p><strong>Approaches:</strong></p>\n<ul>\n<li><strong>Closed Method:</strong> Small <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> to divide the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> under the mucosa.</li>\n<li><strong>Open Technique:</strong> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">Incision</span> through the <span class=\"customMeta\" data-dictid=\"b285d1cdec1692777181bf2a09f9f7\">anoderm</span> for direct access to the internal sphincter.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fissurectomy </strong><strong> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excision of the fissure, including fibrotic edges and associated skin tags.</li>\n<li>Often combined with an anal <span class=\"customMeta\" data-dictid=\"b03362a9691692777180a2605bdfbf\">advancement</span> flap.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anal <span class=\"customMeta\" data-dictid=\"b03362a9691692777180a2605bdfbf\">Advancement</span> Flap</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used when there’s an increased risk of <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> after sphincterotomy, especially in women post-childbirth.</li>\n<li>Involves advancing a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> of healthy skin from the <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> area to cover the fissure, promoting <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> and reducing tension.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZEUQNz9fh3wnN71XS0u41748959825.mp3", "video": ""}, {"text": "A 35-year-old woman with a recurrent anal abscess has developed an anal fistula. She is concerned about continence after surgery. Which surgical option is best to treat her condition while minimizing incontinence risk?", "options": [{"label": "A", "text": "Fistulotomy", "correct": false}, {"label": "B", "text": "Fistulectomy", "correct": false}, {"label": "C", "text": "Setons", "correct": false}, {"label": "D", "text": "Ligation of the Intersphincteric Fistula Tract (LIFT)", "correct": true}], "correct_answer": "D. Ligation of the Intersphincteric Fistula Tract (LIFT)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s8lmHMQpG84U41PfMBhF1739870757.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fistulotomy </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opening the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> to heal by secondary intention.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> and trans-sphincteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> involving &lt;30% of external sphincter; not for <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> in women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fistulectomy </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> using <span class=\"customMeta\" data-dictid=\"24bfc6e0cc16927771862d94b32d73\">diathermy</span> <span class=\"customMeta\" data-dictid=\"be6cf382f3169277718394516c7ca1\">cautery</span> for better <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of anatomy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective for understanding the fistula's <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and extensions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Setons</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Materials are inserted into the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> for <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> or gradual cutting.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loose setons promote drainage; tight/cutting setons cut through muscle over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advancement Flaps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closing the internal opening with a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> is used when the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> complex is not extensively indurated.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective for certain <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> configurations.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S2YcKzygbXdjzAMrQGwA1748959346.mp3", "video": ""}, {"text": "A 1-week-old girl with a newly diagnosed rectovestibular fistula is undergoing evaluation. Which of the following is the most appropriate initial treatment for a newborn with a rectovestibular fistula?", "options": [{"label": "A", "text": "Single-stage anoplasty", "correct": false}, {"label": "B", "text": "Initial colostomy followed by definitive pull-through operation", "correct": true}, {"label": "C", "text": "Wangenstein's Invertogram to determine the level of the rectal pouch", "correct": false}, {"label": "D", "text": "Aspiration of meconium and dye injection for fistula assessment", "correct": false}], "correct_answer": "B. Initial colostomy followed by definitive pull-through operation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:737px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Results from the <span class=\"customMeta\" data-dictid=\"48e662e9b5169277718987f79531ef\">imperfect</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the post-allantoic gut with the proctodaeum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs in 1 in 4500 newborns; associated with anomalies like VATER/VACTERL, including cardiac, trachea-esophageal fistula, renal, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> anomalies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Male: Rectobulbar <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> originating <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the puborectalis)</li>\n<li>Female: <span class=\"customMeta\" data-dictid=\"77fcf51ed01692777197c5e58bccd6\">Rectovestibular</span> fistula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Wangenstein's invertogram</strong> is used to determine the level of the rectal <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> relative to the <span class=\"customMeta\" data-dictid=\"8003951eeb16927771963efc502ca8\">pubococcygeal</span> (Stephen’s) line.</li>\n<li><strong>Murugassu's technique:</strong> Involves <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> of <span class=\"customMeta\" data-dictid=\"19a40edc9816927771924fd7dd0efa\">meconium</span> from the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> to assess <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> level.</li>\n<li>USG abdomen, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function evaluation, <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> spine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Low Fistula: </strong>Single-stage <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> like anoplasty, ano vestibuloplasty, anal dilation, or <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> of the anal <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> with excellent outcomes.</li>\n<li><strong>High Fistula: </strong>Initial <span class=\"customMeta\" data-dictid=\"5c7cf73673169277718428b84f7488\">colostomy</span> followed by a <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> “Pull-through operation” (<strong>posterior <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> anorectoplasty</strong>) and later <span class=\"customMeta\" data-dictid=\"5c7cf73673169277718428b84f7488\">colostomy</span> closure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infection</li>\n<li>Fecal fistula</li>\n<li>Stenosis</li>\n<li>Colitis</li>\n<li>Malnutrition</li>\n<li>Fecal incontinence</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/28WSMnpGlwyIKK4lrGwG1748962994.mp3", "video": ""}, {"text": "A 62 y/o woman diagnosed with rectal carcinoma is being evaluated for treatment options. Which of the following statements regarding the treatment strategies for rectal carcinoma is true?", "options": [{"label": "A", "text": "Total mesorectal excision (TME) is a method of palliative care in patients with advanced rectal cancer.", "correct": false}, {"label": "B", "text": "Neoadjuvant chemoradiotherapy is used after surgical resection to minimize the risk of local recurrence.", "correct": false}, {"label": "C", "text": "Local excision is indicated for early-stage rectal cancers with good prognostic factors.", "correct": true}, {"label": "D", "text": "Abdominoperineal excision (APR) is the preferred surgical approach for all cases of rectal carcinoma.", "correct": false}], "correct_answer": "C. Local excision is indicated for early-stage rectal cancers with good prognostic factors.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:574px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Local Excision</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suitable for early-stage cancers (T1 and selected T2) with good <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> factors; preserves <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and anal sphincter, minimizing <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function impact.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Anterior Resection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred for most cancers in the middle and lower rectum; involves removing affected rectal parts and reconnecting the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> to the remaining rectum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Abdominoperineal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> (APR)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reserved for <strong>low-lying, extensive tumours</strong> unsuitable for sphincter-saving; involves removing rectum, anus, and surrounding tissues, creating a permanent colostomy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hartmann's Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves removing the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> and creating a temporary colostomy, suitable for elderly or frail patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/q50mvpRDliKcIH3Kvg5U1748960466.mp3", "video": ""}, {"text": "A 60-year-old male presents with bright red, painless rectal bleeding and a feeling of incomplete evacuation. Digital rectal examination (DRE) reveals a firm, irregular, palpable mass located 6 cm from the anal verge. Which statement about the clinical features of rectal carcinoma is most accurate?", "options": [{"label": "A", "text": "Tenesmus is a late symptom.", "correct": false}, {"label": "B", "text": "Rectal carcinoma typically presents without any changes in bowel habits.", "correct": false}, {"label": "C", "text": "Rectal carcinoma is most common in patients under 55 years of age.", "correct": false}, {"label": "D", "text": "The presence of a hard mass within 7-8 cm of the anal verge.", "correct": true}], "correct_answer": "D. The presence of a hard mass within 7-8 cm of the anal verge.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Maff1rkmV7i4jwpBxyoN1748960136.mp3", "video": ""}, {"text": "A 24 y/o male presents with intermittent pain and discharge at the natal cleft after experiencing recurrent abscesses in the area. He reports that the symptoms worsen after prolonged sitting and has a history of coarse hair. Upon examination, a midline opening is noted in the natal cleft. What is the most appropriate initial management for this condition?", "options": [{"label": "A", "text": "Complete surgical excision of the sinus", "correct": false}, {"label": "B", "text": "Cauterization using silver nitrate", "correct": false}, {"label": "C", "text": "Drainage through a midline incision", "correct": true}, {"label": "D", "text": "Lateral internal sphincterotomy", "correct": false}], "correct_answer": "C. Drainage through a midline incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5cAqB2nazCzZ8WH2pla71739870879.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For mild cases: cleaning, hair removal, and <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> maintenance.</li>\n<li>Cauterization with silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> or laser in less complex cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drainage through a small <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <strong>(Option C)</strong>.</li>\n<li>Thorough cleaning of the <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to remove <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue and hair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Procedures include:</p>\n<ul>\n<li>Laying open <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracks (with/without marsupialisation)</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (with/without primary closure)</li>\n<li>Off-midline <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> techniques (Limberg, Z-plasty, Karydakis procedures).</li>\n<li>Bascom Procedure: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> to clean the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> cavity, <span class=\"customMeta\" data-dictid=\"e0b35b76f816927771875efaec6acd\">excise</span> midline pits, and leave <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wounds open to heal secondarily.</li>\n<li>Flap Procedures: Used if initial treatments fail or if the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> recurs.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HwtBDMiSX4u3BXlmTt9K1748959968.mp3", "video": ""}, {"text": "A 32 y/o woman presents with severe pain during bowel movements and bright red blood on toilet paper for 2 weeks. She describes the pain as excruciating and sharp, akin to \"passing glass.” Based on this clinical scenario, which of the following statements is correct?", "options": [{"label": "A", "text": "It mainly presents with anal itching &amp;amp; discharge", "correct": false}, {"label": "B", "text": "The hallmark symptom is severe pain during defecation that usually subsides after bowel movements.", "correct": true}, {"label": "C", "text": "This condition is characterized by a thickened anal papilla and a skin tag.", "correct": false}, {"label": "D", "text": "The majority of cases occur in the anterior midline in women due to childbirth.", "correct": false}], "correct_answer": "B. The hallmark symptom is severe pain during defecation that usually subsides after bowel movements.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Anal Fissures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chronic Anal Fissures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma to the anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> lining. (Passage of hard stools, prolonged diarrhoea, childbirth).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased anal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> tone converts <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> to chronic fissure,</p>\n<ul>\n<li>Elevated muscle tension reduces <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the anal canal.</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> leads to a cycle of repeated injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excruciating, sharp pain during <span class=\"customMeta\" data-dictid=\"c411e022421692777185127c6e46f4\">defecation</span> (described as \"passing glass\").</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be less intense than <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> but can still be painful.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration of Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The pain subsides after <span class=\"customMeta\" data-dictid=\"c411e022421692777185127c6e46f4\">defecation</span> but returns with the next <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> movement. <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent pain may occur, with periods of discomfort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bright red blood on toilet paper after wiping.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May also experience blood but less prominently reported.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Exam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Difficult without anaesthesia due to intense pain.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An exam may be possible, with signs of <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> from the skin tag.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Notable pain prevents physical examination; anal spasms may be present.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presents with anal itching, discharge, or <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> fistula. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Identifying Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fresh, <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> in the anal canal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thickened anal <span class=\"customMeta\" data-dictid=\"0a6b15e83616927771941190f46a83\">papilla</span> and <span class=\"customMeta\" data-dictid=\"d3dd03541a1692777198f33a1bb346\">skin tag</span> present; <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> between these structures. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RuzvBMGEKZXBcbKHgeiS1748959669.mp3", "video": ""}, {"text": "A 35 y/o woman presents with severe pain during bowel movements and bright red blood on toilet tissue. Upon examination, the physician suspects an anal fissure. Which of the following characteristics is most likely associated with a chronic anal fissure?", "options": [{"label": "A", "text": "Presence of bright red blood only after bowel movements.", "correct": false}, {"label": "B", "text": "Severe sharp pain during bowel movements that subside afterwards.", "correct": false}, {"label": "C", "text": "Thickened anal papilla and skin tag are present at the fissure site.", "correct": true}, {"label": "D", "text": "Extensive oedema and inflammation", "correct": false}], "correct_answer": "C. Thickened anal papilla and skin tag are present at the fissure site.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kcjTAOsWDTSnhbWrk0Op1739870802.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Anal Fissures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chronic Anal Fissures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fresh, <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> in the anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> lining.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Develop when <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> fissures fail to heal due to ongoing trauma and increased anal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> tone.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe, sharp pain during <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> movements (subsides afterwards)<strong>(Option B ruled out)</strong></li>\n<li>Bright red blood on toilet tissue after wiping<strong>(Option A ruled out)</strong>.</li>\n<li>Physical examination often requires general anaesthesia due to pain.</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of a thickened anal <span class=\"customMeta\" data-dictid=\"0a6b15e83616927771941190f46a83\">papilla</span> and an external skin tag<strong>(Option C)</strong>.</li>\n<li>May cause anal <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> due to <span class=\"customMeta\" data-dictid=\"d3dd03541a1692777198f33a1bb346\">skin tag</span> irritation.</li>\n<li>Discharge from the <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> or a co-existing <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> fistula.</li>\n<li>Often less painful than <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> fissures due to associated inflammation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XsNjl1QOm2q4ZaHEhDWb1748959495.mp3", "video": ""}, {"text": "During a detailed anatomical study, a researcher examines the fascia layers associated with the rectum. Which of the following structures separates the rectum from the prostate in males?", "options": [{"label": "A", "text": "Presacral fascia", "correct": false}, {"label": "B", "text": "Fascia propria", "correct": false}, {"label": "C", "text": "Denonvilliers' fascia", "correct": true}, {"label": "D", "text": "Waldeyer's fascia", "correct": false}], "correct_answer": "C. Denonvilliers' fascia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yi55j8ae1aSl18sKqKpC1739870310.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/esncqRGUKEZn8t4LcBX71748949583.mp3", "video": ""}, {"text": "A 32 y/o male presents with intermittent discharge of pus from an external opening near the anus, accompanied by discomfort and occasional blood in the discharge. He has a history of anorectal abscess treated six months ago and reports pain during bowel movements. Which of the following is the investigation of choice in this case?", "options": [{"label": "A", "text": "Fistulography (X-ray)", "correct": false}, {"label": "B", "text": "Endoscopic Ultrasound", "correct": false}, {"label": "C", "text": "Anoscopy", "correct": false}, {"label": "D", "text": "MRI", "correct": true}], "correct_answer": "D. MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Dq3wv5vHM7j7lqxJqGP21739870705.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maps the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel and provides detailed images of the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscle and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor structures.<strong> </strong><strong>(Investigation of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It uses high-frequency sound waves to identify the fistula, <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscles, and surrounding tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fistulography </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> procedure using <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> contrast to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the anal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination Under Anesthesia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows for thorough evaluation of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel and identification of potential complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fistula Probe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A specialized instrument is inserted through the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> to identify the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anoscopy </strong> <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A small <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> is used to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> for assessment of fistulas during anoscopy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zvNt5NepaEhNpYItJ6rs1748959228.mp3", "video": ""}, {"text": "A 45 y/o male presents to the clinic with a persistent anal discharge and discomfort. He has a history of recurrent perianal abscesses over the past year. O/E an external opening is noted near the anal margin. Which of the following is the most likely cause of the anal fistula in this patient?", "options": [{"label": "A", "text": "Crohn's disease", "correct": false}, {"label": "B", "text": "Tuberculosis", "correct": false}, {"label": "C", "text": "Actinomycosis", "correct": false}, {"label": "D", "text": "Cryptoglandular infection", "correct": true}], "correct_answer": "D. Cryptoglandular infection", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B4XFttNGnKvns0vxrC3I1739870630.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic/Cryptoglandular: The <strong>most common cause</strong>, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.<strong> (Option D)</strong></li>\n<li>Associated Conditions:\n\t\t\t\t<ul>\n<li>Crohn’s disease<strong>(Option A ruled out)</strong></li>\n<li>Tuberculosis <strong>(Option B ruled out)</strong></li>\n<li>Lymphogranuloma venereum</li>\n<li>Actinomycosis <strong>(Option C ruled out)</strong></li>\n<li>Rectal duplication</li>\n<li>Foreign bodies</li>\n<li>Malignancy (rare, can develop within a longstanding fistula)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</li>\n<li>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening, (indicative of a rectal rather than an anal internal opening).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inter- sphincteric (most common, 70%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trans- sphincteric (25%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supra- sphincteric (4%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extra- sphincteric (1%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KiyPOkCDymMRDlX8EvLH1748959105.mp3", "video": ""}, {"text": "A 38-year-old man presents with severe anal pain and a tender, indurated lump at the anal margin. He reports a two-day history of progressively localized pain but has no systemic symptoms such as fever or malaise. What is the next best step in managing this patient?", "options": [{"label": "A", "text": "Immediate antibiotic therapy", "correct": false}, {"label": "B", "text": "Surgical drainage under anaesthesia", "correct": true}, {"label": "C", "text": "Observation and follow-up in 48 hours", "correct": false}, {"label": "D", "text": "Imaging studies to confirm diagnosis", "correct": false}], "correct_answer": "B. Surgical drainage under anaesthesia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perianal Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surrounds the anus, becoming continuous with buttock fat laterally.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painful <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the anal verge, easily diagnosed via physical exam.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ischiorectal Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Located <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the anus, connected posteriorly by the deep <span class=\"customMeta\" data-dictid=\"6a8f5231e216927771962fefccd0e9\">postanal</span> space.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large, often non-visible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> area; detected by digital rectal exam.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intersphincteric Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lies between the internal and external anal sphincters, extending from the <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> space to the rectal wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pain, exacerbated by coughing or sneezing. Diagnosed by <span class=\"customMeta\" data-dictid=\"0a2255da8116927771861c6bc72b58\">DRE</span> under anaesthesia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supralevator <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Located above the <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> ani on either side of the rectum, it may communicate with <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> or <span class=\"customMeta\" data-dictid=\"524700550e169277719083142c660c\">ischiorectal</span> abscesses.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> bulging mass above the <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> ring</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Il7wMhKlbQ3M4lGX0BR01748958980.mp3", "video": ""}, {"text": "A 45-year-old diabetic male reports deep, intense pain \"inside\" the anal area that worsens with coughing or sneezing. The examination shows minimal external swelling, but the significant discomfort prevents a complete digital rectal exam. Given this clinical picture, which type of anorectal abscess is most likely present in this patient?", "options": [{"label": "A", "text": "Perianal Abscess", "correct": false}, {"label": "B", "text": "Ischiorectal Abscess", "correct": false}, {"label": "C", "text": "Intersphincteric Abscess", "correct": true}, {"label": "D", "text": "Supralevator Abscess", "correct": false}], "correct_answer": "C. Intersphincteric Abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2RuRMDWGD81sQjMjoEoG1739870543.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perianal <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> (60%)</strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common type; involves the <span class=\"customMeta\" data-dictid=\"56a39e9dae169277719923b12d72d1\">suppuration</span> of anal glands or infected <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> conditions</li>\n<li>Located near the external sphincter.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ischiorectal <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> (30%)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2nd most common; occurs in the <span class=\"customMeta\" data-dictid=\"524700550e169277719083142c660c\">ischiorectal</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> due to poor vascularization;</li>\n<li>Presents with tender swelling, fever;</li>\n<li>Treated with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> drainage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submucous <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> (5%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs above the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> line, presenting with aching <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> pain</li>\n<li>O/E tender <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> felt on the rectal exam;</li>\n<li>Treated with antibiotics and drainage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supralevator Abscess</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncommon</li>\n<li>Mimics <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> lesions</li>\n<li>Diagnosed by DRE</li>\n<li><strong>Treatment:</strong> The <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> method depends on the <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> origin;\n\t\t\t\t<ul>\n<li>Intersphincteric abscesses- drained rectally,</li>\n<li>Ischiorectal abscesses- <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> through the <span class=\"customMeta\" data-dictid=\"524700550e169277719083142c660c\">ischiorectal</span> fossa.</li>\n<li>Intra-abdominal disease- the primary condition is treated first, with <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> via the most direct route.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nbKEVFcHeGVbSwuwtwip1746105028.mp3", "video": ""}, {"text": "A 55-year-old man presents with difficulty urinating and lower abdominal discomfort. The doctor advises a digital rectal examination (DRE) to assess for potential prostate enlargement or other rectal abnormalities. Which of the following is not an external inspection finding?", "options": [{"label": "A", "text": "Anal fissures", "correct": false}, {"label": "B", "text": "Rectal polyps", "correct": true}, {"label": "C", "text": "Pilonidal sinus", "correct": false}, {"label": "D", "text": "External hemorrhoids", "correct": false}], "correct_answer": "B. Rectal polyps", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>External Inspection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Internal Inspection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anal fissures <strong>(Option A)</strong></li>\n<li>Anal fistula</li>\n<li>Genital warts</li>\n<li>External haemorrhoids <strong>(Option D)</strong></li>\n<li>Pilonidal sinus <strong>(Option C)</strong></li>\n<li>Skin disease (seborrhoeic eczema, skin cancer, natal <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> dermatitis)</li>\n<li>Skin tags</li>\n<li>Skin discoloration with Crohn's disease</li>\n<li>Rectal prolapse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Internal haemorrhoids</li>\n<li>Rectal carcinoma</li>\n<li>Rectal polyps</li>\n<li>Tenderness with <span class=\"customMeta\" data-dictid=\"bf8668fa0e16927771965fbed47263\">prostatitis</span> or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</li>\n<li>Malignant or <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions of the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> palpation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Aiw1aOko7NCnyQJU82O71748951507.mp3", "video": ""}, {"text": "A 72-year-old multiparous woman presents with a painless mass protruding from her anus along with occasional bleeding and fecal incontinence. O/E the mass is circumferential, red in colour, and reducible. Which of the following is the most likely type of rectal prolapse?", "options": [{"label": "A", "text": "Partial prolapse", "correct": false}, {"label": "B", "text": "Mucosal prolapse", "correct": false}, {"label": "C", "text": "Complete prolapse", "correct": true}, {"label": "D", "text": "Internal haemorrhoids", "correct": false}], "correct_answer": "C. Complete prolapse", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:521px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Infants and Children</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased sacral curvature</li>\n<li>Decreased anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> tone</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"281b8ef3701692777185aa34365916\">constipation</span> with straining</li>\n<li>Cough</li>\n<li>Malnutrition</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Anatomical and <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">Physiological</span> Factors</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diastasis of the <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> ani</li>\n<li>Abnormally deep cul-de-sac</li>\n<li>Redundant <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</li>\n<li>Patulous sphincter</li>\n<li>Loss of rectal sacral support</li>\n<li>Lax and atonic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor musculature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Adults</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in females</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"6d72f1e981169277719324bcac3dce\">multiparous</span> women due to repeated birth injuries</li>\n<li>Damage to the <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> nerve supply</li>\n</ul>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> pressure (e.g., chronic cough, <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> urethra)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Partial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complete</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal</li>\n<li>There is no <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer.</li>\n<li>It is the most common type of rectal prolapse.</li>\n<li>History of mass per anum, It is pink in colour and circumferential.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete-full thickness.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> contains all layers of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> (i.e. including the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer).</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> as mass <span class=\"customMeta\" data-dictid=\"be836a0f5e169277719538e60bc715\">per anum</span> circumferentially which is red in colour. Mass is usually <span class=\"customMeta\" data-dictid=\"7b497fabf51692777197384bc1248f\">reducible</span> and painless.</li>\n<li>It may be associated with <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> (uterine procidentia) in females.</li>\n<li>Fecal <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (75%) is very common.</li>\n<li>Bleeding can occur because of the congestion.</li>\n<li>Sepsis, discharge, fever, and anaemia are other features.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z2PARqJLu0CO3cE5o5In1748951168.mp3", "video": ""}, {"text": "A 45-year-old man presents with persistent bleeding from haemorrhoids despite dietary changes and non-operative treatments. Examination reveals third-degree internal haemorrhoids. Which of the following is not an indication of hemorrhoidectomy?", "options": [{"label": "A", "text": "Third-degree haemorrhoids", "correct": false}, {"label": "B", "text": "Second-degree haemorrhoids", "correct": true}, {"label": "C", "text": "'Mixed' haemorrhoids with a well-defined external component", "correct": false}, {"label": "D", "text": "Fourth-degree haemorrhoids", "correct": false}], "correct_answer": "B. Second-degree haemorrhoids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closed Haemorrhoidectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The Parks or Ferguson <span class=\"customMeta\" data-dictid=\"688498a587169277718835ead0f24e\">hemorrhoidectomy</span> involves <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of <span class=\"customMeta\" data-dictid=\"5007cb01671692777188d8ea08cd2e\">hemorrhoidal</span> tissue and <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the wounds with an <span class=\"customMeta\" data-dictid=\"330e2bf7d216927771804326d05181\">absorbable</span> suture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open Haemorrhoidectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In Milligan and <span class=\"customMeta\" data-dictid=\"8057385f2d1692777192dbb5247114\">Morgan</span> hemorrhoidectomy, wounds are left open and allowed to heal by secondary intention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Whitehead’s Hemorrhoidectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Whitehead’s <span class=\"customMeta\" data-dictid=\"688498a587169277718835ead0f24e\">hemorrhoidectomy</span> involves <span class=\"customMeta\" data-dictid=\"57793361701692777184c3bc13c91d\">circumferential</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"5007cb01671692777188d8ea08cd2e\">hemorrhoidal</span> cushions just <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> to the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> line</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapled <span class=\"customMeta\" data-dictid=\"688498a587169277718835ead0f24e\">Hemorrhoidectomy</span> (Longo)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Procedure for <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">Prolapse</span> and Hemorrhoids (PPH), also known as stapled hemorrhoidopexy, is an <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> procedure for second and third-degree haemorrhoids.</li>\n<li>It uses a <span class=\"customMeta\" data-dictid=\"3b4c96c9d01692777199d56349e8d8\">stapling</span> device to remove redundant <span class=\"customMeta\" data-dictid=\"5007cb01671692777188d8ea08cd2e\">hemorrhoidal</span> tissue and mucosa, <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">ligate</span> <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> venules, and fix the tissue above the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> line.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:415px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Early</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Late</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>● Pain</p>\n<p>● <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of urine</p>\n<p>● Reactionary haemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>● Secondary hemorrhage</p>\n<p>● Anal stricture</p>\n<p>● Anal fissure</p>\n<p>● Incontinence</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XbbD6GEx8BJvNuzw98Vu1748950920.mp3", "video": ""}, {"text": "A 50-year-old woman presents with bright red bleeding during defecation and a prolapsed haemorrhoid that cannot be reduced manually. What is the most suitable management for this patient?", "options": [{"label": "A", "text": "Dietary and lifestyle changes", "correct": false}, {"label": "B", "text": "Rubber band ligation", "correct": false}, {"label": "C", "text": "Sclerotherapy", "correct": false}, {"label": "D", "text": "Hemorrhoidectomy", "correct": true}], "correct_answer": "D. Hemorrhoidectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:736px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rubber Band Ligation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective for persistent <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in first, second, and selected third-degree haemorrhoids by strangulating tissue to prevent further <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or prolapse. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infrared Photocoagulation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suitable for small first and second-degree haemorrhoids, coagulating the underlying plexus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sclerotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves injecting <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> agents into first, second, and some third-degree haemorrhoids to cause fibrosis. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Excision of <span class=\"customMeta\" data-dictid=\"d32945833c16927772005b5e05a44f\">Thrombosed</span> External Hemorrhoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elliptical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> under local anaesthesia for acutely <span class=\"customMeta\" data-dictid=\"d32945833c16927772005b5e05a44f\">thrombosed</span> external haemorrhoids causing intense pain.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operative Hemorrhoidectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elective <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> haemorrhoids by decreasing <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and excising redundant tissue.Used in 3rd and 4th-degree haemorrhoids <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Doppler-Guided <span class=\"customMeta\" data-dictid=\"5007cb01671692777188d8ea08cd2e\">Hemorrhoidal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Ligation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses a <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> to identify and <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">ligate</span> arteries <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> the <span class=\"customMeta\" data-dictid=\"5007cb01671692777188d8ea08cd2e\">hemorrhoidal</span> plexus, promising for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> hemorrhoids but long-term effectiveness is still being evaluated.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/74OIq8LvCtHa6bgZXKe01748950752.mp3", "video": ""}, {"text": "A 45-year-old man reports experiencing bright red bleeding during bowel movements and a mass that protrudes from his anus, which he can manually reduce but does not reduce spontaneously. On examination, no thrombosed haemorrhoids are observed. Which degree of internal haemorrhoids is this patient most likely suffering from?", "options": [{"label": "A", "text": "First degree", "correct": false}, {"label": "B", "text": "Second degree", "correct": false}, {"label": "C", "text": "Third degree", "correct": true}, {"label": "D", "text": "Fourth degree", "correct": false}], "correct_answer": "C. Third degree", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Internal Haemorrhoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>External Haemorrhoids</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Above the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> line, covered with <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Below the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> line, covered with skin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (covered by insensate <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> mucosa)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painful bleeding(anoderm is richly innervated, <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of an external haemorrhoid may cause significant pain)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment- depends on the degree</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment- <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of external haemorrhoids</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z9AsJlG2JmOkm3cJCYQq1748950600.mp3", "video": ""}, {"text": "A 55 y/o woman presents with complaints of rectal bleeding and discomfort during bowel movements. She mentions experiencing chronic constipation and frequent straining. Which pathophysiological mechanism is most likely contributing to her haemorrhoids?", "options": [{"label": "A", "text": "High-fiber diet", "correct": false}, {"label": "B", "text": "Well-supported suspensory tissues", "correct": false}, {"label": "C", "text": "Excess venous drainage", "correct": false}, {"label": "D", "text": "Increased intra-abdominal pressure", "correct": true}], "correct_answer": "D. Increased intra-abdominal pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6ODOD7h1rIR8iYpIugsk1739870430.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gUIlSfG6NOYy7nu9Md9m1748949676.mp3", "video": ""}, {"text": "A 58 y/o male presents with rectal cancer located just distal to the dentate line. During his evaluation for metastatic spread, which lymph nodes are most likely to be involved given the location of his cancer?", "options": [{"label": "A", "text": "Internal iliac lymph nodes", "correct": false}, {"label": "B", "text": "Inferior mesenteric lymph nodes", "correct": false}, {"label": "C", "text": "Para-aortic lymph nodes", "correct": false}, {"label": "D", "text": "Inguinal lymph nodes", "correct": true}], "correct_answer": "D. Inguinal lymph nodes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BhI26EVmIDn5WwzDw0l21739870377.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5yx6bhLvKi6eCPmJRFBR1747152753.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 36 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 3-year-old child with short bowel syndrome presents with severe malabsorption. Which surgical procedure involves stapling a dilated bowel into V shapes on alternating sides, decreasing the width and increasing the bowel length to improve nutrient absorption?", "options": [{"label": "A", "text": "Bianchi procedure", "correct": false}, {"label": "B", "text": "Whipple Procedure", "correct": false}, {"label": "C", "text": "Billroth I and II Procedures", "correct": false}, {"label": "D", "text": "STEP procedure", "correct": true}], "correct_answer": "D. STEP procedure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RzA6F9ERsdsBxafKvNPI1739936829.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ew3sirLMx9BKCu1jeQSk1748929785.mp3", "video": ""}, {"text": "A 6-year-old child with a history of extensive small bowel resection due to necrotizing enterocolitis is diagnosed with short bowel syndrome. Which among the following surgical procedures can help increase the bowel length and potentially reduce the dependency on parenteral nutrition?", "options": [{"label": "A", "text": "Bianchi procedure", "correct": true}, {"label": "B", "text": "Whipple Procedure", "correct": false}, {"label": "C", "text": "Billroth I and II Procedures", "correct": false}, {"label": "D", "text": "Ileostomy", "correct": false}], "correct_answer": "A. Bianchi procedure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XuMlpj2PmvIlyQiMVZOn1745398092.mp3", "video": ""}, {"text": "A 45-year-old male presents with severe malnutrition and liver dysfunction even after subclavian parenteral nutrition for extensive small bowel resection. Which of the following is the most definitive treatment for his condition?", "options": [{"label": "A", "text": "Jugular Parenteral Nutrition (TPN)", "correct": false}, {"label": "B", "text": "Small bowel transplantation", "correct": true}, {"label": "C", "text": "Serial transverse enteroplasty", "correct": false}, {"label": "D", "text": "Ileostomy", "correct": false}], "correct_answer": "B. Small bowel transplantation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AQsXPrNOe6fitI44u0Aj1748929630.mp3", "video": ""}, {"text": "A 52-year-old male patient who underwent extensive resection of the small intestine for Crohn’s disease presents with persistent diarrhea and worsening malnutrition. Despite following a strict dietary regimen, he is unable to maintain adequate nutritional status or fluid balance without intravenous support. What is the most appropriate management strategy for this patient?", "options": [{"label": "A", "text": "Oral rehydration therapy", "correct": false}, {"label": "B", "text": "Enteral nutrition", "correct": false}, {"label": "C", "text": "Parenteral nutrition", "correct": true}, {"label": "D", "text": "Antidiarrheal medications", "correct": false}], "correct_answer": "C. Parenteral nutrition", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IzKgZPtp5eUz20gIk9931748929412.mp3", "video": ""}, {"text": "A 60-year-old woman with a history of extensive small bowel resection presents with persistent diarrhea, significant weight loss, and signs of malnutrition. She is unable to maintain adequate fluid and nutritional balance despite dietary modifications. what condition is she most likely experiencing?", "options": [{"label": "A", "text": "Intestinal obstruction", "correct": false}, {"label": "B", "text": "Short bowel syndrome", "correct": true}, {"label": "C", "text": "Celiac disease", "correct": false}, {"label": "D", "text": "Crohn’s disease", "correct": false}], "correct_answer": "B. Short bowel syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8YuNqJwHDBKPD3UM43g81748927218.mp3", "video": ""}, {"text": "A 55-year-old patient with radiation enteritis undergoes bowel resection and develops short bowel syndrome. Which statement about bowel function is correct?", "options": [{"label": "A", "text": "The jejunum compensates well for the loss of the ileum.", "correct": false}, {"label": "B", "text": "The ileum can compensate for a resected jejunum due to better absorption.", "correct": true}, {"label": "C", "text": "Short bowel syndrome is less severe with distal bowel loss.", "correct": false}, {"label": "D", "text": "The ileum’s compensation is reduced due to looser junctions.", "correct": false}], "correct_answer": "B. The ileum can compensate for a resected jejunum due to better absorption.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aEg08nweppEWy9ooBtUm1748927081.mp3", "video": ""}, {"text": "A 60-year-old man presents with complaints of fatigue, shortness of breath, and swelling in his legs. He has had a history of intermittent facial flushing and diarrhea for the past several years. Physical examination reveals a new heart murmur. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Aortic stenosis", "correct": false}, {"label": "B", "text": "Mitral regurgitation", "correct": false}, {"label": "C", "text": "Carcinoid heart disease", "correct": true}, {"label": "D", "text": "Pulmonary embolism", "correct": false}], "correct_answer": "C. Carcinoid heart disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZU9dgdSA6I6gTFRKPQ3i1748926676.mp3", "video": ""}, {"text": "Which of the following diagnostic steps is most appropriate to establish a definitive diagnosis of abdominal TB in this patient?", "options": [{"label": "A", "text": "Serum-ascites albumin gradient (SAAG) measurement", "correct": false}, {"label": "B", "text": "Computed tomography (CT) with enterography protocol", "correct": false}, {"label": "C", "text": "Peritoneal fluid adenosine deaminase (ADA) level", "correct": false}, {"label": "D", "text": "Biopsy of the involved site with mycobacterial culture and nucleic acid amplification test (NAAT)", "correct": true}], "correct_answer": "D. Biopsy of the involved site with mycobacterial culture and nucleic acid amplification test (NAAT)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definitive Diagnosis </strong><strong>(Option D)</strong></p>\n</td>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>M. <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> Demonstration:</strong></p>\n<ul>\n<li><strong>Peritoneal fluid (in ascites)</strong></li>\n<li><strong>Biopsy <span class=\"customMeta\" data-dictid=\"c02ad9ae0f1692777198d76afc93c4\">specimen</span> (peritoneum, intestine, liver)</strong></li>\n<li><strong>Mycobacterial culture and/or NAAT:</strong></li>\n<li><strong>Histopathology: </strong>The presence of caseating granulomas suggests TB but is not pathognomonic</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"15\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radiographic Imaging</p>\n</td>\n<td rowspan=\"15\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CT with <span class=\"customMeta\" data-dictid=\"e1fea778701692777187155d3315ec\">Enterography</span> Protocol: </strong><strong>(Option B ruled out)</strong></p>\n<p>Preferred for cross-sectional evaluation</p>\n<ul>\n<li><strong>Intestinal TB: </strong>Concentric <span class=\"customMeta\" data-dictid=\"b61dc1c68d1692777193f8a6b8809b\">mural</span> thickening in the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> region, <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> with <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> centers</li>\n<li><strong>Peritoneal TB: </strong>Ascites, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, <span class=\"customMeta\" data-dictid=\"9f51fc9a741692777192ec164a061f\">mesentery</span> and omental thickening, peritoneal thickening</li>\n<li><strong>Hepatic TB:</strong>\n<ul>\n<li><strong>Miliary disease:</strong> Multiple low-density micronodules throughout the liver</li>\n<li><strong>Local disease:</strong> Large <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> or 2-3 low-density nodules with <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> enhancement</li>\n</ul>\n</li>\n</ul>\n<p><strong>Ultrasound:</strong></p>\n<p>Detects lymphadenopathy, ascites, peritoneal thickening, omental thickening, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall thickening</p>\n<p><strong>Other Imaging:</strong></p>\n<ul>\n<li><strong>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> follow-through/barium enema:</strong> Mucosal ulcerations, strictures, deformed cecum, <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> valve</li>\n<li><strong>Plain radiography:</strong> Air fluid levels, dilated small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> calcifications</li>\n<li><strong>Chest radiography:</strong> For suspected <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> TB</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ascitic Fluid Analysis</p>\n</td>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Routine Tests:</strong></p>\n<ul>\n<li>Cell count and differential, <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> and protein concentration, <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> stain</li>\n</ul>\n<p><strong>TB-specific Tests:</strong></p>\n<ul>\n<li>ADA level <strong>(Option C ruled out)</strong>, AFB smear, mycobacterial culture, <span class=\"customMeta\" data-dictid=\"537e1064fa1692777193225ce9f5d0\">NAAT</span> for M. <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (if available)</li>\n</ul>\n<p><strong>Typical Findings:</strong></p>\n<ul>\n<li>Lymphocytic <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> with <span class=\"customMeta\" data-dictid=\"d3185ca21e169277719836a0dcdaf0\">SAAG</span> &lt;1.1 g/dL in noncirrhotic patients <strong>(Option A ruled out)</strong></li>\n<li>Straw-colored ascites</li>\n<li>leukocyte count 150-4000 cells/mm³</li>\n<li>relative lymphocytic pleocytosis</li>\n<li>Protein content &gt;3.0 g/dL</li>\n</ul>\n<p>The sensitivity of AFB <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> and mycobacterial culture is low</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Biopsy Specimens</p>\n</td>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<ul>\n<li><strong>Laparoscopy:</strong> <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">Visualization</span> of peritoneum, peritoneal biopsy</li>\n<li><strong>Endoscopy:</strong> Biopsies in the setting of intestinal involvement</li>\n<li><strong>Radiographic-guided interventions</strong></li>\n<li><strong>Histopathology:</strong>\n<ul>\n<li>Caseating granulomas and positive <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> in fewer than 33% of cases</li>\n<li>Confluent granulomas, granulomas &gt;400 micrometres, &gt;5 granulomas in one segment, and <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> granulomas suggest TB enteritis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Tools</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Tuberculin skin test/interferon-gamma release assay:</strong> Positive in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> TB but limited value (does not <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> active disease from <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> infection)</li>\n<li><strong>Stool PCR:</strong> Useful adjunctive tool for diagnosing intestinal TB</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OMje8TVUDJfJG7Wz4d7f1748925866.mp3", "video": ""}, {"text": "A 65-year-old male presents with sudden onset severe abdominal pain that started 30 minutes after his last meal. He is tachycardic and hypotensive and laboratory investigations reveal leukocytosis and elevated chromogranin A levels. A CT scan shows bowel wall enhancement and free fluid in the abdomen. Which of the following is the most preferred treatment?", "options": [{"label": "A", "text": "Segmental resection + En-bloc lymphadenectomy", "correct": true}, {"label": "B", "text": "Chemotherapy regimen", "correct": false}, {"label": "C", "text": "Somatostatin analogue therapy", "correct": false}, {"label": "D", "text": "Total bowel resection", "correct": false}], "correct_answer": "A. Segmental resection + En-bloc lymphadenectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vkjnqtob8B9yP1eqoa0n1748926919.mp3", "video": ""}, {"text": "A 48-year-old woman presents with episodes of flushing, diarrhea, and abdominal pain over the past six months. She also reports intermittent wheezing and feels her symptoms worsen after consuming certain foods. On physical examination, she exhibits a rash on her face and neck. Imaging studies reveal a tumor in the ileum of the small intestine. What is the initial investigation of choice for localisation in this patient?", "options": [{"label": "A", "text": "Contrast-enhanced CT abdomen", "correct": false}, {"label": "B", "text": "DOPA-PET", "correct": false}, {"label": "C", "text": "Urinary detention of 5-HIAA", "correct": false}, {"label": "D", "text": "Somatostatin receptor scintigraphy (SRS)", "correct": true}], "correct_answer": "D. Somatostatin receptor scintigraphy (SRS)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BOWWpa28RcXnQ9tUGLyA1748926394.mp3", "video": ""}, {"text": "What is the most peculiar feature of gastric carcinoid tumor?", "options": [{"label": "A", "text": "Abdominal pain", "correct": false}, {"label": "B", "text": "Abdominal distension", "correct": false}, {"label": "C", "text": "Bowel obstruction", "correct": false}, {"label": "D", "text": "Bright red patchy flushing of skin", "correct": true}], "correct_answer": "D. Bright red patchy flushing of skin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JMH4rwErwt6HtJD8UG4G1748926269.mp3", "video": ""}, {"text": "A 55 y/o male presents with flushing, diarrhea, and recurrent episodes of bronchospasm. Imaging reveals multiple masses in the ileum. Laboratory tests show elevated serotonin levels. What is the most likely type of tumor responsible for his symptoms?", "options": [{"label": "A", "text": "Foregut Carcinoid Tumor", "correct": false}, {"label": "B", "text": "Midgut Carcinoid Tumor", "correct": true}, {"label": "C", "text": "Hindgut Carcinoid Tumor", "correct": false}, {"label": "D", "text": "Non-Syndromic Neuroendocrine Tumor", "correct": false}], "correct_answer": "B. Midgut Carcinoid Tumor", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/obAnErJI3Xjq0yfhwjuP1748926173.mp3", "video": ""}, {"text": "Which of the following statements is correct?", "options": [{"label": "A", "text": "The most common small bowel tumor in adults is carcinoid tumor.", "correct": false}, {"label": "B", "text": "The most common small bowel tumor in children is a neuroendocrine tumor.", "correct": false}, {"label": "C", "text": "The most common primary malignant small bowel tumor is adenocarcinoma.", "correct": true}, {"label": "D", "text": "The most common small bowel tumor in adults is lymphoma.", "correct": false}], "correct_answer": "C. The most common primary malignant small bowel tumor is adenocarcinoma.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Classification of Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> Tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Benign Tumors</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Adenomas: <strong>Most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> SBT is adenoma</strong></li>\n<li>Lipomas</li>\n<li>Haemangiomas</li>\n<li>Neurogenic tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Malignant Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Adenocarcinoma </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Found more often in the <span class=\"customMeta\" data-dictid=\"4b145c8d1b1692777190177246177d\">jejunum</span> than the ileum.</li>\n<li>Associated with Crohn's disease, <span class=\"customMeta\" data-dictid=\"d5a3301c521692777184c2e69756d0\">coeliac</span> disease, FAP, HNPCC, and Peutz–Jeghers syndrome.</li>\n<li><strong>The most common primary <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> SBT is: <span class=\"customMeta\" data-dictid=\"362992dbb11692777180f9017fc04d\">Adenocarcinoma</span> &gt; Carcinoid&gt;Lymphoma and</strong><strong> </strong><strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neuroendocrine Tumors (NETs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Arise from Kulchitsky cells, small primary tumor with potential for significant <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastases, up to one-third involve multiple tumors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lymphomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Can be primary or secondary to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> lymphoma, increased <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in patients with Crohn's disease and <span class=\"customMeta\" data-dictid=\"141d29cc7f16927771890a8e0860e6\">immunodeficiency</span> syndromes.</li>\n<li><strong>The most common SBT in children is Lymphoma. (Opti</strong><strong>on B and D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gastrointestinal Stromal Tumors (GISTs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Mesenchymal tumors, are difficult to classify as <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> or malignant, with larger size and high c-kit (CD117) <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> associated with malignancy. Found throughout the gut, most commonly in the stomach.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6EcnRARsAeSaCl4OTBDZ1748926038.mp3", "video": ""}, {"text": "A 65 y/o male presents with chronic abdominal discomfort and bloating. Imaging shows multiple jejunal diverticula. The physician suspects these are due to increased intraluminal pressure. What is the most likely etiology of these diverticula?", "options": [{"label": "A", "text": "Congenital origin due to incomplete recanalization of the duodenum", "correct": false}, {"label": "B", "text": "Acquired origin due to smooth muscle motor dysfunction", "correct": true}, {"label": "C", "text": "Remnant of the omphalomesenteric duct", "correct": false}, {"label": "D", "text": "Protrusion of the entire intestinal wall layers", "correct": false}], "correct_answer": "B. Acquired origin due to smooth muscle motor dysfunction", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/50SIQITaS2HxKuez57YQ1748924563.mp3", "video": ""}, {"text": "A 28-year-old patient with gastrointestinal tuberculosis presents with abdominal pain and intermittent diarrhea. Imaging studies reveal a long, narrow filling defect in the terminal ileum. What is the most likely diagnosis based on these findings?", "options": [{"label": "A", "text": "Ulcerative tuberculosis with subacute obstruction and perforation", "correct": false}, {"label": "B", "text": "Crohn’s disease with a narrowed segment and proximal distension", "correct": false}, {"label": "C", "text": "Hyperplastic tuberculosis with a filling defect in the terminal ileum and lymphadenopathy", "correct": true}, {"label": "D", "text": "Appendicitis with mass in the right iliac fossa", "correct": false}], "correct_answer": "C. Hyperplastic tuberculosis with a filling defect in the terminal ileum and lymphadenopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative Tuberculosis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperplastic Tuberculosis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diarrhea</li>\n<li>Weight loss</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal pain</li>\n<li>Intermittent diarrhea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications/Consequences</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subacute obstruction</li>\n<li>Perforation</li>\n<li>Fistula formation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incomplete ileal obstruction</li>\n<li>Stasis</li>\n<li>Bacterial overgrowth</li>\n<li>Steatorrhea</li>\n<li>Anemia</li>\n<li>Weight loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Barium follow-through/CT: Absence of contrast <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ileum, caecum, and <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> due to narrowing of an ulcerated segment</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physical exam: Mass in right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> fossa</li>\n<li>Barium follow-through/small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> enema: Long, narrow <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> ileum</li>\n<li>CT scan: Narrowed segment with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> distension and lymphadenopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QHEdu4VAK9qwDBtSGLEi1747151650.mp3", "video": ""}, {"text": "A patient with pulmonary tuberculosis is diagnosed with ulcers in the terminal ileum. Which form of gastrointestinal tuberculosis is characterized by this presentation?", "options": [{"label": "A", "text": "Hyperplastic tuberculosis with intestinal wall thickening.", "correct": false}, {"label": "B", "text": "Ulcerative tuberculosis with transverse ulcers and serosal thickening.", "correct": true}, {"label": "C", "text": "Crohn’s disease with abscesses and fistulas.", "correct": false}, {"label": "D", "text": "Hyperplastic tuberculosis with abscesses and fistulas.", "correct": false}], "correct_answer": "B. Ulcerative tuberculosis with transverse ulcers and serosal thickening.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> of <em>Mycobacterium tuberculosis</em>, often in those with <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</li>\n<li>Results in multiple <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> ulcers, primarily in the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> ileum.</li>\n<li>Leads to thickening and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the serosa, covered in tubercles.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperplastic Tuberculosis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Develops in individuals with high resistance to <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> who ingest the bacteria.</li>\n<li>Commonly affects the ileocaecal region and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ileum.</li>\n<li>Causes <span class=\"customMeta\" data-dictid=\"e025d338b21692777184b4a309cbfb\">chronic inflammation</span> in <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> follicles, thickening of the intestinal wall, and narrowing of the lumen.</li>\n<li>Less likely to cause abscesses and fistulas, and often presents with regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement with potential caseation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/P4J5VUMc7R4e6gD3R0fW1748925728.mp3", "video": ""}, {"text": "A 35-year-old male presents with symptoms of abdominal pain and weight loss. He has a history of pulmonary tuberculosis. On examination, his abdomen is tender in the right iliac fossa. A barium follow-through study reveals a long, narrow filling defect in the terminal ileum. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Crohn's disease", "correct": false}, {"label": "B", "text": "Hyperplastic tuberculosis", "correct": true}, {"label": "C", "text": "Appendicitis", "correct": false}, {"label": "D", "text": "Carcinoma of the ileum", "correct": false}], "correct_answer": "B. Hyperplastic tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative Tuberculosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperplastic <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> </strong><strong>(Option A)</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> tuberculosis; <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ingestion of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> by individuals with high resistance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminal ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ileocaecal region; can also affect the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ileum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> ulcers.</li>\n<li>Thickened and inflamed <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> with tubercles.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> in <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> follicles.</li>\n<li>Thickening of the intestinal wall and <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> narrowing.</li>\n<li>Rare <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> and <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> formation.</li>\n<li>Early involvement of regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, which may caseate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium <span class=\"customMeta\" data-dictid=\"858805ab951692777203ea929e3df0\">follow-through</span> and CT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> due to narrowing of ulcerated segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long narrow <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defect</li>\n<li>CT shows a narrowed segment with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> distension</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/anEr4RQRC0oupeXt6tOg1748925626.mp3", "video": ""}, {"text": "A 25-year-old female with a history of weight loss presents with intermittent abdominal pain, nausea, and vomiting. Imaging shows compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. Conservative dietary management has failed. What is the next best step in management?", "options": [{"label": "A", "text": "Laparoscopic duodenojejunostomy", "correct": true}, {"label": "B", "text": "Open duodenal bypass surgery", "correct": false}, {"label": "C", "text": "Continued conservative management", "correct": false}, {"label": "D", "text": "Open duodenojejunostomy", "correct": false}], "correct_answer": "A. Laparoscopic duodenojejunostomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strong Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duodenum is mobilized by dividing the <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of Treitz. Once the duodenal jejunal <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> is mobilized, the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> is positioned to the right of the superior mesenteric artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No risk of anastomotic leak.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic <span class=\"customMeta\" data-dictid=\"c82b8d02d51692777186798478774c\">Duodenojejunostomy</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Optimal <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment; involves creating a <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> from the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> to the jejunum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally invasive, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> recovery times and lower <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rates compared to open surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Procedures</strong><strong> (Option B &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Employed when <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> methods are not feasible or have failed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes <span class=\"customMeta\" data-dictid=\"c82b8d02d51692777186798478774c\">duodenojejunostomy</span> or other <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> surgeries; higher morbidity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Interventions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative management (dietary modifications, nutritional support) is attempted first but often fails. <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical intervention is necessary for severe <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or significant weight loss.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/43WRlPfftL77FRUJn0Zg1748925440.mp3", "video": ""}, {"text": "A 30 y/o male with a history of rapid weight loss presents with severe postprandial abdominal pain and vomiting. The physician suspects Superior Mesenteric Artery (SMA) syndrome. Which imaging technique is most suitable for visualizing the compression of the duodenum by the SMA and accurately measuring the aortomesenteric angle?", "options": [{"label": "A", "text": "Endoscopy", "correct": false}, {"label": "B", "text": "Computed Tomography (CT) Scan", "correct": true}, {"label": "C", "text": "Barium X-ray Study", "correct": false}, {"label": "D", "text": "Abdominal Ultrasound", "correct": false}], "correct_answer": "B. Computed Tomography (CT) Scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ro3PtpadyS7tyBDvoI9h1747830078.mp3", "video": ""}, {"text": "Which of the following is NOT TRUE regarding superior mesenteric artery syndrome?", "options": [{"label": "A", "text": "Early satiety and postprandial epigastric pain are present.", "correct": false}, {"label": "B", "text": "The knee to the chest or left lateral decubitus position alleviates symptoms.", "correct": false}, {"label": "C", "text": "Presentation is always acute, needing emergency intervention.", "correct": true}, {"label": "D", "text": "All of the above.", "correct": false}], "correct_answer": "C. Presentation is always acute, needing emergency intervention.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NwhFHdHF2lWNBy1JV2lV1748925269.mp3", "video": ""}, {"text": "Which part of the duodenum is compressed in superior mesenteric artery syndrome?", "options": [{"label": "A", "text": "First", "correct": false}, {"label": "B", "text": "Second", "correct": false}, {"label": "C", "text": "Third", "correct": true}, {"label": "D", "text": "Fourth", "correct": false}], "correct_answer": "C. Third", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/L3LLlml9Z0M8ImTpL5zP1739936713.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/V8p45xDcPh0G7CKMfRq61748925143.mp3", "video": ""}, {"text": "A 6-year-old boy is diagnosed with symptomatic Meckel's diverticulum after presenting with painless rectal bleeding. The diverticulum is found to be inflamed and with ulcers in the base. Which of the following surgical procedures is most appropriate for this patient?", "options": [{"label": "A", "text": "Amputation at base and invagination.", "correct": false}, {"label": "B", "text": "Resection of small bowel with diverticulum.", "correct": true}, {"label": "C", "text": "Ileostomy.", "correct": false}, {"label": "D", "text": "Diverticulectomy.", "correct": false}], "correct_answer": "B. Resection of small bowel with diverticulum.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lbyLh0JbHEuATxCMXzwT1739936653.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WmO9DqeueuKcLuBTCFMp1748925061.mp3", "video": ""}, {"text": "A 7-year-old boy presents with intermittent episodes of blood in his stools without pain. On examination, there are no signs of acute abdomen. Blood investigations reveal he is anemic. Which is the investigation of choice in this case for Meckel's diverticulum?", "options": [{"label": "A", "text": "USG abdomen", "correct": false}, {"label": "B", "text": "Colonoscopy", "correct": false}, {"label": "C", "text": "Tc-pertechnetate scan", "correct": true}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "C. Tc-pertechnetate scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vcDZpW1T66oMydrJ8T8M1739936574.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/buZRMXIs7NhmCzwbg0eB1748924956.mp3", "video": ""}, {"text": "A 2-year-old boy presents with painless rectal bleeding. CT scans show a diverticulum 2 inches long located around 2 feet proximal to the ileocaecal valve. A Technetium-99m pertechnetate scan shows an area of increased uptake in the right lower quadrant. What is the most likely type of ectopic mucosal tissue found in the diverticulum that can explain these findings?", "options": [{"label": "A", "text": "Gastric", "correct": true}, {"label": "B", "text": "Pancreatic", "correct": false}, {"label": "C", "text": "Colonic", "correct": false}, {"label": "D", "text": "Jejunal", "correct": false}], "correct_answer": "A. Gastric", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7td1mBbTVnKGqkOITB551748924830.mp3", "video": ""}, {"text": "Which of the following characteristics is true regarding Meckel's diverticulum?", "options": [{"label": "A", "text": "Located approximately 30 cm from the ileocecal valve.", "correct": false}, {"label": "B", "text": "Always lined with ectopic pancreatic tissue", "correct": false}, {"label": "C", "text": "Arises from the mesenteric border of the ileum.", "correct": false}, {"label": "D", "text": "Contains all the layers of the bowel wall.", "correct": true}], "correct_answer": "D. Contains all the layers of the bowel wall.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LfsZvy03XNR8fsSeLHaT1739936509.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/q1W3JGdm2gTZypCGAKQA1748924712.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements about the spleen is not true?", "options": [{"label": "A", "text": "Normal adult spleen weights 75–250 g.", "correct": false}, {"label": "B", "text": "The long axis lies along the 10th rib.", "correct": false}, {"label": "C", "text": "It develops from the mesenchymal cells of the ventral mesogastrium.", "correct": true}, {"label": "D", "text": "It is an intraperitoneal organ", "correct": false}], "correct_answer": "C. It develops from the mesenchymal cells of the ventral mesogastrium.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FbBFzOH0VO6uOttdoh8C1740024203.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/d4egh34udQ0zFoU8AQPC1746106641.mp3", "video": ""}, {"text": "What is the most common indication for a splenectomy?", "options": [{"label": "A", "text": "Hereditary spherocytosis", "correct": false}, {"label": "B", "text": "Idiopathic thrombocytopenic purpura (ITP)", "correct": false}, {"label": "C", "text": "Trauma", "correct": true}, {"label": "D", "text": "Abscess", "correct": false}], "correct_answer": "C. Trauma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WaIt2N0nGzfo1A4e7RCU1746108200.mp3", "video": ""}, {"text": "A 45-year-old male is planned for an elective splenectomy due to hereditary spherocytosis. Which of the following vaccination strategies is most appropriate to prevent infections post-splenectomy?", "options": [{"label": "A", "text": "10-12 weeks before surgery", "correct": false}, {"label": "B", "text": "Only if the patient shows signs of infection", "correct": false}, {"label": "C", "text": "Delay all vaccinations until 6 months after surgery", "correct": false}, {"label": "D", "text": "At least one week before the surgery", "correct": true}], "correct_answer": "D. At least one week before the surgery", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Vaccine</strong></th>\n<th><strong>Children</strong></th>\n<th><strong>Adults (≥19 years)</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Pneumococcal</strong></td>\n<td>PCV13 → PPSV23 (8 weeks later) → Repeat PPSV23 after 5 years</td>\n<td>PCV13 → PPSV23 (8 weeks later) → Repeat PPSV23 every 5 years</td>\n</tr>\n<tr>\n<td><strong>Meningococcal</strong></td>\n<td>MenACWY <strong>series</strong> + MenB <strong>series</strong></td>\n<td>MenACWY or MPSV4 (2 doses, 2 months apart) → Repeat MenACWY every 5 years<br/>\n\t\t\t+ MenB <strong>series once</strong></td>\n</tr>\n<tr>\n<td><strong>Haemophilus influenzae type b</strong></td>\n<td>Single dose if ≥15 months and unvaccinated</td>\n<td>Single dose if not previously vaccinated</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Scenario</strong></th>\n<th><strong>Recommendation</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Elective <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> (ideal)</strong></td>\n<td>10–12 weeks before surgery <em>(optimal for immune response)</em></td>\n</tr>\n<tr>\n<td><strong>Elective <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> (minimum)</strong></td>\n<td><strong>At least 2 weeks before</strong> surgery</td>\n</tr>\n<tr>\n<td><strong>Emergency splenectomy</strong></td>\n<td>At hospital <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> <strong>or</strong> 14 days post-op, <strong>whichever <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> first</strong></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PLCiisj31yoYUlx6iA4Z1746108351.mp3", "video": ""}, {"text": "An elderly male undergoes an open splenectomy due to splenic rupture following a car accident. In the postoperative room, he complains of shortness of breath and chest discomfort. What is the MOST common immediate complication after a splenectomy?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Left basal atelectasis", "correct": true}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "B. Left basal atelectasis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Q26xsW3aSxZmH8XqBcSk1746108494.mp3", "video": ""}, {"text": "A 25-year-old woman with thalassemia major undergoes an elective splenectomy. She is informed about potential complications and the need for vaccinations. When is the most common Fatal late complication of splenectomy most likely to occur?", "options": [{"label": "A", "text": "Within the first 6 months", "correct": false}, {"label": "B", "text": "1-2 years post-splenectomy", "correct": false}, {"label": "C", "text": "2-5 years post-splenectomy", "correct": true}, {"label": "D", "text": "5-10 years post-splenectomy", "correct": false}], "correct_answer": "C. 2-5 years post-splenectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xRpYv7HxuOlJNDjEXqUA1746108639.mp3", "video": ""}, {"text": "A 4-year-old boy is brought to the clinic with a history of sudden onset of petechial hemorrhages and purpuric patches on the skin. The mother also reports episodes of spontaneous epistaxis over the past few days. He had a flu-like illness a few weeks ago. Laboratory investigations show isolated thrombocytopenia. Which of the following symptoms is most likely to be seen in this patient?", "options": [{"label": "A", "text": "Equal incidence in both males and females", "correct": true}, {"label": "B", "text": "Predominantly seen in females aged 15-50", "correct": false}, {"label": "C", "text": "Associated with renal dysfunction", "correct": false}, {"label": "D", "text": "Hemolytic anemia and jaundice", "correct": false}], "correct_answer": "A. Equal incidence in both males and females", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:545px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Diagnostic Feature</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Finding</strong></p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Palpable Spleen</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Uncommon in ITP; may suggest an alternative diagnosis</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Coagulation Studies</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Normal</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Bleeding Time Tests</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Not useful in diagnosing ITP</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Cutaneous Ecchymoses</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Present</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Tourniquet Test</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Positive</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Complete Blood Count</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count (&lt; 60 x 10⁹/L)</p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Aspiration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased megakaryocytes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JWcc3F28RY9GDJEM1MY81746108958.mp3", "video": ""}, {"text": "A 45-year-old patient presents with persistent petechiae, frequent nosebleeds, and heavy menstrual bleeding over the past 7 months. She is being considered for splenectomy. Which statement accurately reflects the current approach to this treatment?", "options": [{"label": "A", "text": "Laparoscopic splenectomy is preferred.", "correct": true}, {"label": "B", "text": "Long-term steroid therapy is the primary approach.", "correct": false}, {"label": "C", "text": "Approximately 50% of patients will achieve complete remission post-splenectomy.", "correct": false}, {"label": "D", "text": "All patients receive pre-splenectomy transfusions immediately", "correct": false}], "correct_answer": "A. Laparoscopic splenectomy is preferred.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fZ4LVPFR6mZa6cmsgtvi1746109133.mp3", "video": ""}, {"text": "A 30-year-old patient presents with an abdominal mass. Imaging studies reveal a cystic structure in the spleen. Based on the imaging characteristics and the absence of an epithelial lining, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Cystic hemangioma", "correct": false}, {"label": "B", "text": "Mesenchymal Inclusion Cyst", "correct": false}, {"label": "C", "text": "Secondary cyst", "correct": true}, {"label": "D", "text": "Dermoid cyst", "correct": false}], "correct_answer": "C. Secondary cyst", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lUyXf3SCNBGhrKsViG881746109340.mp3", "video": ""}, {"text": "A 45-year-old patient undergoes a splenectomy for an incidental finding. Histological examination of the spleen reveals a vascular tumor. Which of the following is the most likely type of tumor identified?", "options": [{"label": "A", "text": "Histiocytic Lymphoma", "correct": false}, {"label": "B", "text": "Hemangioendothelioma", "correct": true}, {"label": "C", "text": "Non-Hodgkin’s Lymphoma", "correct": false}, {"label": "D", "text": "Plasmacytoma", "correct": false}], "correct_answer": "B. Hemangioendothelioma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2dUr66BM4QRDtFPbLewM1746109486.mp3", "video": ""}, {"text": "A 45-year-old patient presents with a one-week history of persistent left upper abdominal pain. The patient exhibits fever, left upper quadrant tenderness, and leukocytosis. Which of the following is the investigation of choice for confirming the diagnosis?", "options": [{"label": "A", "text": "Chest X-ray", "correct": false}, {"label": "B", "text": "Abdominal Ultrasound", "correct": false}, {"label": "C", "text": "Computed Tomography (CT)", "correct": true}, {"label": "D", "text": "Radioisotope Scanning", "correct": false}], "correct_answer": "C. Computed Tomography (CT)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiography</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray:</strong> Non-specific for splenic abscess; may show:</p>\n<ul>\n<li>Elevated left <span class=\"customMeta\" data-dictid=\"dd7d149ec4169277718822fd0f1841\">hemidiaphragm</span> (&gt;30%)</li>\n<li>Pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> (&gt;20%)</li>\n</ul>\n<p><strong>Abdominal X-ray</strong>: Non-specific; possible findings include:</p>\n<ul>\n<li>Abnormal soft-tissue density</li>\n<li>Gas collection in the left upper quadrant</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nuclear Studies</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radioisotope scanning: Limited value due to long test duration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasonography</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cost-effective and non-invasive, but:</li>\n<li>Nonspecific and operator-dependent</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Computed <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (CT)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Criterion standard for diagnosing splenic abscess</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4g9WUclMR6xyWFmV3d521746109612.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 56-year-old man arrives in the emergency department with severe upper gastrointestinal bleeding. On examination, he is pale, hypotensive, and has a rapid pulse. Which of the following is the initial priority in managing this patient?", "options": [{"label": "A", "text": "Immediate endoscopy to identify the bleeding source", "correct": false}, {"label": "B", "text": "Assessment of airway, breathing, and circulation (ABCs) with intravenous access establishment", "correct": true}, {"label": "C", "text": "Administration of terlipressin for suspected variceal bleeding", "correct": false}, {"label": "D", "text": "Blood transfusion to raise hemoglobin above 10 g/dL", "correct": false}], "correct_answer": "B. Assessment of airway, breathing, and circulation (ABCs) with intravenous access establishment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> UGI bleed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">Stabilization</span> and Resuscitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prioritise assessment of airway, breathing, and <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> (ABCs). Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> access with two large-bore catheters for fluid resuscitation.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Stratification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use the Glasgow-Blatchford Score (GBS) for early risk assessment.</p>\n<p>Patients with a <span class=\"customMeta\" data-dictid=\"aa23182e651692777188296980e246\">GBS</span> of 0 are low-risk and may not need hospital admission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">Transfusion</span> Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adopt a restrictive <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> strategy, aiming for a haemoglobin level of 70–90 g/L. Consider a more liberal <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> approach only in cases of massive blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In suspected <span class=\"customMeta\" data-dictid=\"d4607865bb1692777201a35341db81\">variceal</span> bleeding, administer <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> terlipressin to improve outcomes and reduce the need for additional interventions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role of Endoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perform <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> urgently in unstable patients and within 24 hours for others.</p>\n<p>Endoscopy serves to:</p>\n<ul>\n<li>Identify the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> source.</li>\n<li>Assess <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> using criteria like the Forrest classification.</li>\n</ul>\n<p>Treat with techniques such as:</p>\n<ul>\n<li>Injection therapy: <span class=\"customMeta\" data-dictid=\"35b6a8aeb416927771805fcc2e7dfb\">Adrenaline</span> injection.</li>\n<li>Thermal coagulation: Using heat probes or electrocoagulation.</li>\n<li>Mechanical methods: <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> clips to close <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> sites.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative Interventions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> fails or <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> recurs, consider <span class=\"customMeta\" data-dictid=\"a8eaf87aaa1692777190add0bad040\">interventional radiology</span> or surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Endoscopy Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-risk patients should receive <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump inhibitors (PPIs) for 72 hours, followed by twice-daily oral <span class=\"customMeta\" data-dictid=\"6d17c6d6f1169277719687447037f2\">PPI</span> for 11 days.</p>\n<p>Address underlying conditions, including the eradication of H. pylori if present, to prevent rebleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zUB2gyYsgmPRBr4DsxDD1745764316.mp3", "video": ""}, {"text": "A patient is being evaluated for suspected gastric carcinoma, and on his upper GI endoscopy, a lesion is noticed. The lesion appears ulcerative. Under Borrmann’s classification, which type of carcinoma is this?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": true}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "C. Type III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/n7WH3eIApYWO1pmUsKf51739937082.png", "https://image.prepladder.com/content/fW1HHGGoQ1jyJ855ab551739937281.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:355px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>The gross appearance of the lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polypoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fungating</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II<strong> </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcerating</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffusely infiltrating growths</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type IV<strong> </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:547px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Intestinal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diffuse </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Environmental</li>\n<li>Gastric atrophy, intestinal <span class=\"customMeta\" data-dictid=\"cb4dfcbab11692777192d282b3be7a\">metaplasia</span> women</li>\n<li>Men&gt; Women</li>\n<li>Increasing <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> with age</li>\n<li>Gland formation</li>\n<li>Hematogenous spread</li>\n<li>Microsatellite instability</li>\n<li>APC gene mutations</li>\n<li>p53, p16 inactivation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Familial</li>\n<li>Blood type A</li>\n<li>Women &gt; men</li>\n<li>Younger age group</li>\n<li>Poorly differentiated, <span class=\"customMeta\" data-dictid=\"3ed98cf4b71692777198c4a2ea968a\">signet ring</span> cells</li>\n<li>Transmural, <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> spread</li>\n<li>Decreased E-cadherin</li>\n</ul>\n<ul>\n<li>p53, p16 inactivation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Intestinal variant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diffuse <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> adenocarcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Well-differentiated</li>\n<li>Typically arises from a recognizable precancerous condition</li>\n<li>Men are more commonly affected than women</li>\n<li>Increases with age</li>\n<li>Have a tendency to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> glands</li>\n<li>It is the dominant <span class=\"customMeta\" data-dictid=\"ebf8f256f3169277718992ac1b2330\">histology</span> in areas in which <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer is epidemic, suggesting an environmental cause (H-pylori)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consists of tiny clusters of small, uniform <span class=\"customMeta\" data-dictid=\"3ed98cf4b71692777198c4a2ea968a\">signet ring</span> cells</li>\n<li>Poorly differentiated</li>\n<li>Lacks glands</li>\n<li>Early metastatic spread via <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> extension and <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> invasion</li>\n<li>Generally not associated with chronic gastritis</li>\n<li>Equally frequent in both sexes,</li>\n<li>Affects a slightly younger age group</li>\n<li>Association with <span class=\"customMeta\" data-dictid=\"8cb71c753c16927771831c74cb7271\">blood type</span> A and <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> occurrence. <span class=\"customMeta\" data-dictid=\"e47e248094169277719000b0ed02ea\">Intraperitoneal</span> <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> are frequent</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> is less favourable</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kNz7kmkUZR8TlxclQY8p1745764203.mp3", "video": ""}, {"text": "A male patient comes to the clinic due to abdominal pain. He is a chronic smoker and has never been consistent with a healthy diet. An endoscopy and biopsy of the lesion in his stomach confirm gastric cancer. Which of the following statements regarding risk factors of gastric carcinoma is false?", "options": [{"label": "A", "text": "High-salt foods like salted or smoked meat increase the risk of gastric carcinoma", "correct": false}, {"label": "B", "text": "H-pylori is the most common infectious cause of gastric carcinoma", "correct": false}, {"label": "C", "text": "Adenomatous polyps carry a risk of turning cancerous", "correct": false}, {"label": "D", "text": "Proton pump inhibitors have a protective effect against gastric cancer", "correct": true}], "correct_answer": "D. Proton pump inhibitors have a protective effect against gastric cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-salt foods (e.g., salted and smoked meats), low <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> of fruits and vegetables<strong> </strong><strong>(Option A)</strong></p>\n<p>N-nitroso compounds are formed from nitrates in high-salt and smoked foods; Similar to tobacco smoke</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle habits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking, alcohol, poor food preparation (smoked, salted), lack of refrigeration, contaminated drinking water, low socioeconomic status</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infectious Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>H- pylori infection: </strong>M/c <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> cause of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer. <strong>(Option B)</strong></p>\n<p>Mechanism: <span class=\"customMeta\" data-dictid=\"e025d338b21692777184b4a309cbfb\">Chronic inflammation</span> leading to atrophic gastritis, intestinal metaplasia, dysplasia, and carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polyps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenomatous polyps (risk of malignancy) <strong>(Option C)</strong></li>\n<li>In multiple polyps, the largest one is excised, and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> from others is taken.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>E-cadherin (CDH1) gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (hereditary <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer)</li>\n<li>Hereditary cancer syndromes</li>\n<li><strong>Li- Fraumeni syndrome</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proton pump inhibitors</strong> (long-term use creates low-acid environment achlorhydria; Risk for H. pylori colonization) <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastric ulcers, <span class=\"customMeta\" data-dictid=\"5cc1ea37091692777195fbd0aa687b\">pernicious</span> anaemia (achlorhydria), obesity, Epstein-Barr virus, prior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"35bafad73816927771904e162f4a70\">irradiation</span> (for testicular cancer or Hodgkin’s lymphoma), prior <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> surgery, male sex</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/B2PNgOLRipH0L6E8moBe1745764064.mp3", "video": ""}, {"text": "A 50-year-old male comes to the OPD for a follow-up of peptic ulcer disease. He has had an upper gastrointestinal bleed in the recent past and was endoscopically and medically managed. A repeat endoscopy is done to assess his risk of rebleed and a flat pigmented spot is viewed in the duodenum. According to the Forrest classification system, what is the classification of the ulcer and risk of rebleed observed here?", "options": [{"label": "A", "text": "IA, high risk", "correct": false}, {"label": "B", "text": "IIB, high risk", "correct": false}, {"label": "C", "text": "III, low risk", "correct": false}, {"label": "D", "text": "IIC, low risk", "correct": true}], "correct_answer": "D. IIC, low risk", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stigmata of recent haemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Forrest classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk of rebleed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Active bleeding\n\t\t\t\t<ul>\n<li>Active spurting</li>\n<li>Active oozing</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>IA <strong>(OptionA)</strong></p>\n<p>IB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>90%</p>\n<p>10% - 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recent haemorrhage\n\t\t\t\t<ul>\n<li>Non-bleeding visible vessel</li>\n<li>Adherent clot</li>\n<li><strong>Flat <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> spot</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>IIA</p>\n<p> </p>\n<p>IIB <strong>(OptionB)</strong></p>\n<p><strong>IIC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>50%</p>\n\t\t\t \n\n\t\t\t<p>25% - 30%</p>\n<p><strong>5% - 10%</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No signs of haemorrhage\n\t\t\t\t<ul>\n<li>Clean-based ulcer</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>III <strong>(OptionC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3% - 5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PCAGXr3HwU9Nrqm6e1za1745763922.mp3", "video": ""}, {"text": "A 40-year-old patient is brought to the emergency department with melena and dizziness. Her BP is 100/ 80 mmHg, and her pulse rate is 100 bpm. Her lab investigations reveal Hb of 8 gm/dL and a blood urea nitrogen (BUN) of 25 mg/dL. Based on the Blatchford score, which of the following findings would most significantly increase her risk stratification score? a. Systolic blood pressure less than 100 mm of Hg b. High blood urea nitrogen level (&amp;gt; 25) c. Diagnosis of Mallory Weiss syndrome d. Heart rate more than 100 bpm", "options": [{"label": "A", "text": "a and b only", "correct": false}, {"label": "B", "text": "a, b and c", "correct": false}, {"label": "C", "text": "a, c and d", "correct": false}, {"label": "D", "text": "a, b and d", "correct": true}], "correct_answer": "D. a, b and d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Blatchford score </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Rockall- Bayler score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for initial assessment in case of bleeds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most useful as it is based on <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> findings</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulse</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">Urea</span> nitrogen</li>\n<li>Systolic Blood pressure</li>\n<li>Haemoglobin</li>\n<li>Presence of\n\t\t\t\t<ul>\n<li>Melena</li>\n<li>Syncope</li>\n<li>Hepatic or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> dysfunction</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Comorbid disease (cardiac, hepatic, renal, or disseminated)</li>\n<li>Age (&lt;60 years, 60-79 years, &gt;80 years)</li>\n<li>Shock\n\t\t\t\t<ul>\n<li>Systolic BP &lt;100 mm Hg</li>\n<li>Pulse rate &gt;100 beats/min</li>\n</ul>\n</li>\n<li><strong>Diagnosis at the time of <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> (Non-malignant lesions, or <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> lesions like Mallory weiss syndrome, GI malignancy) </strong></li>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"a65f1844f1169277719926ce076cb3\">Stigmata</span> of recent bleed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/c7ZwHzg11U8SHDUgd6rq1745395359.mp3", "video": ""}, {"text": "A 60-year-old patient presents with sudden, massive hematemesis. An upper endoscopy identifies a small mucosal defect surrounded by normal gastric mucosa. Angiography reveals a large, tortuous artery in the left gastric artery distribution. What is the underlying pathophysiological mechanism of bleeding in Dieulafoy’s lesion?", "options": [{"label": "A", "text": "Erosion of the mucosa due to excessive acid secretion", "correct": false}, {"label": "B", "text": "Rupture of varices caused by portal hypertension", "correct": false}, {"label": "C", "text": "Erosion of mucosa due to pulsations from a large submucosal artery", "correct": true}, {"label": "D", "text": "Ulceration of the gastric mucosa due to chronic use of NSAIDs", "correct": false}], "correct_answer": "C. Erosion of mucosa due to pulsations from a large submucosal artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8bRewPzgYsZ1AUSc9xRk1739936865.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Dieulafoy’s lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Dieulafoy's <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is characterized by an abnormally large, <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> that runs through the <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> of the stomach without a primary ulcer.</li>\n<li>Artery measures 1-3 mm and is typically found near the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> along the lesser curvature.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> develops as the pulsations of the large <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"f30224cb791692777187d1ea81e717\">erode</span> the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> mucosa. <strong>(Option C)</strong></li>\n<li>The mucosal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is usually small, measuring 2-5 mm, and is surrounded by normal-appearing <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa. Once the <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> is exposed to <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> contents, further <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> occur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>More common in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> (2:1 ratio) and is associated with <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease, chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, and diabetes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sudden onset of massive, painless <span class=\"customMeta\" data-dictid=\"a835b61f5216927771880a4c6e0a00\">hematemesis</span> (vomiting blood).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Endoscopy: </strong>Primary tool, identifies <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in 80% of cases; repeat may be needed.</p>\n<p><strong>Angiography:</strong> Used if <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> is inconclusive; shows <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and potential contrast extravasation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Endoscopic Therapy: </strong></p>\n<ul>\n<li>Bipolar electrocoagulation,</li>\n<li>Heater <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> thermocoagulation,</li>\n<li>Injection sclerotherapy,</li>\n<li>Endoscopic hemoclipping.</li>\n</ul>\n<p><strong>Angiographic Embolization: </strong></p>\n<ul>\n<li>Used when <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> fails.</li>\n</ul>\n<p><strong>Surgery: </strong></p>\n<ul>\n<li>Wedge <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of the stomach if other methods fail; <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> or <span class=\"customMeta\" data-dictid=\"16777b606e16927772006cbb6869ce\">tattooing</span> aids in locating the lesion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LzKCR7iukLYxsK8dAwLN1745763679.mp3", "video": ""}, {"text": "A 62-year-old female with a history of liver cirrhosis presents with symptoms of chronic gastrointestinal bleeding, including anaemia and fatigue. Upper endoscopy is shown below. Which of the following is the most appropriate initial treatment for this condition?", "options": [{"label": "A", "text": "Radiofrequency ablation", "correct": false}, {"label": "B", "text": "Hormonal therapy", "correct": false}, {"label": "C", "text": "Argon plasma coagulation", "correct": true}, {"label": "D", "text": "Reducing portal pressure", "correct": false}], "correct_answer": "C. Argon plasma coagulation", "question_images": ["https://image.prepladder.com/content/iwgqjD8cJDQ1dil1YVPw1739882183.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gastric Antral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> <span class=\"customMeta\" data-dictid=\"def85be6371692777186604c253b12\">Ectasia</span> (GAVE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Portal <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">Hypertensive</span> <span class=\"customMeta\" data-dictid=\"f4be23ef2a1692777188c7931e75e2\">Gastropathy</span> (PHG)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GAVE is a condition characterized by dilated blood vessels in the <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> of the stomach, often resembling the pattern of a <strong>watermelon.</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PHG is a condition associated with <strong>portal hypertension</strong><strong>,</strong> marked by a mosaic-like pattern of <strong>red and white spots on the stomach lining.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flat, reddish stripes radiating from the <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> into the antrum, resembling a watermelon.</p>\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Alkhormi, Abdulrahman &amp; Memon, Muhammad Yousuf &amp; Alqarawi, Abdullah. (2018). Gastric Antral &lt;span class=\" data-dictid=\"526ede3fee169277720184378acc5e\"/>Vascular Ectasia: A Case Report and Literature Review. Journal of translational internal medicine. 6. 47-51. 10.2478/jtim-2018-0010. \" data-hash=\"\" data-license=\"CC BY-NC-ND 3.0\" data-source=\"https://www.researchgate.net/figure/Striped-watermelon-appearance-of-gastric-antral-vascular-ectasia_fig4_324172241\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/ceLrQdqLO4EXNTLHrwal1739936044.png\" width=\"400\" /&gt;</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A mosaic-like pattern of red and white spots on the stomach lining, typically in the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> and upper body.</p>\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Onuigbo, Macaulay &amp; Agbasi, Nneoma &amp; Achebe, Jennifer &amp; Odenigbo, Charles &amp; Oguejiofor, Fidelis. (2016). Pleuritic chest pain from &lt;span class=\" data-dictid=\"a74252404f1692777196d3f24bde2d\"/>portal <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> <span class=\"customMeta\" data-dictid=\"f4be23ef2a1692777188c7931e75e2\">gastropathy</span> in ESRD patient with autosomal dominant polycystic kidney disease misdiagnosed as pericarditis. Journal of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Injury Prevention. 5. 48-52. 10.15171/jrip.2016.11. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Shows-portal-hypertensive-gastropathy-PHG-changes-evident-on-upper-GI-endoscopy_fig3_298328872\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/KczSbIeeHDVwjMHB9cko1739936118.png\" width=\"400\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur in patients with cirrhosis, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disorders, and chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Always associated with <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence in Cirrhosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (around 2-8%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Much more common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated mucosal capillaries, <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> thrombi, and <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cell <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> - <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> ectasia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastric <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> showing dilated and distended capillaries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> (e.g., <span class=\"customMeta\" data-dictid=\"06a6e8bfbb169277718202d47f2d42\">Argon</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> Coagulation, <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> Band Ligation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reducing <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> pressure <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Jd5vGHJbTEvGfHx3BuWn1745763477.mp3", "video": ""}, {"text": "A 58-year-old woman visits her primary care physician complaining of persistent upper abdominal pain that worsens after meals. She also reports experiencing nausea and occasional vomiting. After a thorough clinical evaluation, the physician suspects a gastric ulcer. What investigation should be done multiple times as a must in case of a gastric ulcer?", "options": [{"label": "A", "text": "Endoscopy", "correct": false}, {"label": "B", "text": "Endoscopy with biopsy", "correct": true}, {"label": "C", "text": "Assessment for H pylori", "correct": false}, {"label": "D", "text": "Ultrasonography", "correct": false}], "correct_answer": "B. Endoscopy with biopsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WyEpyqVufDWpo570sr2f1739881818.png", "https://image.prepladder.com/content/A5mA4giQhahVrolWj8RZ1739881887.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Lhss8YaBTDABfVriRklx1745733612.mp3", "video": ""}, {"text": "A patient presents with early satiety, weight loss, nausea, and vomiting. An upper endoscopy reveals a narrowing of the pylorus due to inflammation and scarring from peptic ulcer disease. What is the most appropriate initial step in managing this patient's gastric outlet obstruction?", "options": [{"label": "A", "text": "Surgical antrectomy with reconstruction and vagotomy", "correct": false}, {"label": "B", "text": "Endoscopic dilation with stent placement", "correct": false}, {"label": "C", "text": "Placement of a nasogastric tube and correction of fluid/electrolyte imbalances", "correct": true}, {"label": "D", "text": "Immediate initiation of H. pylori eradication therapy", "correct": false}], "correct_answer": "C. Placement of a nasogastric tube and correction of fluid/electrolyte imbalances", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:677px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gastric Outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (GOO) from <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">Peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">Ulcer</span> Disease (PUD)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GOO </strong>occurs when the passage of food from the stomach to the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> is blocked.</p>\n<p>Inflammation and <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> from ulcers in the <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> or duodenum, lead to a narrowing of the <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> tract.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early satiety, Anorexia, Weight loss, Feeling of fullness</li>\n<li>Nausea and vomiting,</li>\n<li>Abdominal pain, Dilated stomach,</li>\n<li>Dehydration and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> (from prolonged vomiting)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Approach</strong>: <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">Differentiate</span> PUD vs malignancy.</p>\n<ul>\n<li><strong>Endoscopy:</strong> Directly visualizes the <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> to evaluate <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> and obtain biopsies to rule out cancer.</li>\n<li>Assess for H. pylori infection. <strong>(Option D)</strong></li>\n<li><strong>Contrast Radiology:</strong> Assesses <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> narrowing and <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> severity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Stabilization</strong>: <strong>(Option C)</strong></p>\n<ul>\n<li>Gastric Decompression: NG tube placement.</li>\n<li>Fluid and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> Correction: <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">Intravenous</span> fluids and electrolytes.</li>\n<li>Nutritional Support: Dietary modifications, <span class=\"customMeta\" data-dictid=\"b36da50c8d169277718782ffc6960b\">enteral</span> or <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> nutrition.</li>\n</ul>\n<p><strong>Addressing Underlying PUD</strong>:</p>\n<ul>\n<li>Medical Therapy: H. pylori eradication therapy, <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">Proton</span> pump inhibitors (PPIs).</li>\n<li>Endoscopic Dilation: <span class=\"customMeta\" data-dictid=\"7e9bc153d616927771866a8608d1a5\">Dilate</span> narrowed <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> area; <span class=\"customMeta\" data-dictid=\"cb33defbb316927771991b2ef81ec3\">stent</span> placement<strong> </strong><strong>(Option B)</strong>.</li>\n</ul>\n<p><strong>Surgical Intervention</strong>:</p>\n<ul>\n<li>Antrectomy with <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">Reconstruction</span> and Vagotomy: Removal of antrum, stomach reconnection, and <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerve cutting<strong> (Option A)</strong>.</li>\n<li>Vagotomy with <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> Procedure: Jaboulay Gastroduodenostomy, Gastrojejunostomy, Pyloroplasty.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Gastrectomy Syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dumping Syndrome</strong>: Rapid <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of food into the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> causing <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> and <span class=\"customMeta\" data-dictid=\"bd99ec780c16927772018a45db80c2\">vasomotor</span> symptoms (abdominal pain, nausea, diarrhoea, sweating, palpitations)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qHRGo6gfGEKqlmPUvJMt1745762917.mp3", "video": ""}, {"text": "A 45-year-old male with a history of chronic alcoholism presents to the emergency department after a night of intense vomiting following a drinking binge. He complains of severe upper abdominal pain and is found to have hematemesis. An urgent upper GI endoscopy is performed, revealing a mucosal laceration near the GE junction. Which of the following is not a management option for the above condition?", "options": [{"label": "A", "text": "Multipolar electrocoagulation", "correct": false}, {"label": "B", "text": "Epinephrine injection", "correct": false}, {"label": "C", "text": "Endoscopic band ligation", "correct": false}, {"label": "D", "text": "Balloon tamponade", "correct": true}], "correct_answer": "D. Balloon tamponade", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gWmAX8h7SjvhMILP8bJb1738896060.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Boerhaave Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mallory-Weiss Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oesophageal perforation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucosal <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> near the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> junction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forceful vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forceful vomiting, retching, coughing, or straining</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The lower part of the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> (left side)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastroesophageal junction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vomiting, chest pain, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> emphysema, pleural effusion, fever, tachycardia, tachypnea, crunching sound on heart auscultation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vomiting, hematemesis, upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, hypotension, tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pleural effusion, increased <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality if delayed diagnosis and treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely massive bleeding, associated with <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical evaluation, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical evaluation, endoscopy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drainage, <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of perforation, supportive measures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic methods (multipolar electrocoagulation, <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> injection, band ligation), angiographic transarterial embolization, rarely surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor if not treated promptly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally good with appropriate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> treatment</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jeFZIye0byENFkJ0DdVi1745763305.mp3", "video": ""}, {"text": "Which of the following is NOT a cause of upper gastrointestinal bleeding?", "options": [{"label": "A", "text": "Peptic Ulcer Disease", "correct": false}, {"label": "B", "text": "Esophageal Varices", "correct": false}, {"label": "C", "text": "Mallory-Weiss Tear", "correct": false}, {"label": "D", "text": "Angiodysplasia", "correct": true}], "correct_answer": "D. Angiodysplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peptic Ulcers</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bleeding from <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulcers in the stomach or <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> is a common cause of upper GI bleeding.</li>\n<li>MC <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> involved in\n\t\t\t\t<ul>\n<li>Duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> - <span class=\"customMeta\" data-dictid=\"5f1eca7eaa1692777188e4f8827ef9\">Gastroduodenal</span> artery</li>\n<li>Gastric <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> - Left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"d6ccfc448916927771877d9bde179f\">Erosive</span> Gastritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation and <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the stomach lining, are often caused by alcohol, NSAIDs, and stress, leading to bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oesophagitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One of the most common aetiology for UGI. It refers to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or injury to the oesophageal mucosa. It can be <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> oesophagitis, infection oesophagitis, pill-induced ( alendronate, tetracycline, doxycycline, NSAIDs, aspirin), <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> oesophagitis and radiation-induced oesophagitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mallory-Weiss Syndrome</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tears in the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> or stomach, are typically caused by severe vomiting, resulting in significant bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal Varices</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged veins in the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> that can <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> and bleed, are commonly a <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of chronic liver disease. Primarily due to<strong> <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> Hypertension.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours in the stomach can cause bleeding, often microscopic, leading to anaemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric Polyps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign growths in the stomach lining can be a source of bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dieulafoy's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare condition with an abnormally large <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> in the <span class=\"customMeta\" data-dictid=\"fda3b47a5c16927771994ab38f8a22\">stomach wall</span> that can cause significant <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> if the <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> erodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric Antral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> <span class=\"customMeta\" data-dictid=\"def85be6371692777186604c253b12\">Ectasia</span> (GAVE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated blood vessels in the stomach lining that can bleed, are often seen in individuals with liver disease or <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conditions affecting blood <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> that can contribute to upper GI bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term use of aspirin, NSAIDs, and corticosteroids increases the risk of ulcers and bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zollinger-Ellison Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare disorder causing excessive stomach acid production, leading to severe <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulcers that are <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nnnjgRH1LuuRfF9l1omJ1745763157.mp3", "video": ""}, {"text": "During a Billroth II procedure, the surgeon carefully dissects the pyloric region. Which of the following statements about this area's anatomy is most accurate?", "options": [{"label": "A", "text": "The right gastric artery originates directly from the celiac trunk", "correct": false}, {"label": "B", "text": "The vagus nerve forms a single identifiable trunk in this region", "correct": false}, {"label": "C", "text": "Lymph nodes here drain exclusively into the pancreaticolienal group", "correct": false}, {"label": "D", "text": "The gastroduodenal artery passes posterior to the first part of the duodenum", "correct": true}], "correct_answer": "D. The gastroduodenal artery passes posterior to the first part of the duodenum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/haAZPumqUYCwNcjxKjKX1739880402.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vxJCCWYqp9qop1MglYtk1745731336.mp3", "video": ""}, {"text": "A 65-year-old man presents with severe epigastric pain and black, tarry stools. He has a history of chronic gastritis and NSAID use for osteoarthritis. Upper GI endoscopy reveals a gastric ulcer and a biopsy is taken for histological analysis. According to the modified Johnson’s criteria, what type of ulcer is most likely?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type IV", "correct": false}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type V", "correct": true}], "correct_answer": "D. Type V", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KRnRZQcLoCS2utdV21bM1739881722.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acid level</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcer at lesser curve incisura angularis</p>\n<p>Most common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low to normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcer at the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> body and</p>\n<p>Duodenal ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcer is pre-pyloric</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcers higher on the lesser curvature, M/C type to bleed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any location/throughout the stomach but NSAID-induced ulcers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wDOwkz6DFfTHaSuJOFVF1745733251.mp3", "video": ""}, {"text": "A 60-year-old male with a long-standing history of duodenal ulcer on treatment with proton pump inhibitors presents to the clinic with sudden severe epigastric pain, rebound tenderness, and air under the diaphragm. Based on this history, what is the complication?", "options": [{"label": "A", "text": "Perforated duodenal ulcer", "correct": true}, {"label": "B", "text": "Pyloric stenosis", "correct": false}, {"label": "C", "text": "Gastric outlet obstruction", "correct": false}, {"label": "D", "text": "Hourglass deformity of stomach", "correct": false}], "correct_answer": "A. Perforated duodenal ulcer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xPkSZJWjDipFX6PhwBbk1739881533.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YUr5f2PM1tHt3FRPHd4x1745732908.mp3", "video": ""}, {"text": "A 35-year-old man comes to the clinic with pain in the epigastrium and uneasiness for 2 months, which is temporarily relieved by antacids. He has a history of smoking and takes nonsteroidal anti-inflammatory drugs (NSAIDs) occasionally for back pain. An upper gastrointestinal endoscopy reveals a duodenal ulcer. What would be the best line of treatment in this case?", "options": [{"label": "A", "text": "H. pylori eradication", "correct": false}, {"label": "B", "text": "Proton pump inhibitors", "correct": true}, {"label": "C", "text": "Antacids like aluminium hydroxide", "correct": false}, {"label": "D", "text": "Highly selective vagotomy", "correct": false}], "correct_answer": "B. Proton pump inhibitors", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rr3oPZ2LVJRy73OpguMt1745732735.mp3", "video": ""}, {"text": "A 50-year-old woman with a history of gastric carcinoma comes to the OPD with abdominal pain, early satiety, diarrhoea, and bloating. On examination, she is tachycardic and has palpitations. She also complains of headaches. She has undergone partial gastrectomy and Billroth type II reconstruction. What is the diagnosis here?", "options": [{"label": "A", "text": "Recurrence of gastric carcinoma", "correct": false}, {"label": "B", "text": "Dumping syndrome", "correct": true}, {"label": "C", "text": "Gastric ulcer, Type V", "correct": false}, {"label": "D", "text": "Irritable bowel syndrome", "correct": false}], "correct_answer": "B. Dumping syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ftWE2lHLz0ZXat79rze11739881302.png", "https://image.prepladder.com/content/7INowz2mXPfm2swut6mX1739881345.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Early Dumping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Late Dumping</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is seen <strong>within 30 minutes</strong> of meals</li>\n<li>Worsens with food intake</li>\n<li>Relieved by lying down</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"558\" src=\"https://image.prepladder.com/content/ftWE2lHLz0ZXat79rze11739881302.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is seen<strong> after 1-3 hours</strong> of meals</li>\n<li>Less common</li>\n<li>Worsens with exercise</li>\n<li>Relieved by food</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"652\" src=\"https://image.prepladder.com/content/7INowz2mXPfm2swut6mX1739881345.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment: <strong>Intravenous fluids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment: <strong>Oral glucose</strong> is given</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KE2Q6I53hdv6OH8ubHrQ1745732554.mp3", "video": ""}, {"text": "A 60-year-old male with a history of peptic ulcer disease underwent partial gastrectomy with Roux-en-Y reconstruction five years ago. He presents with symptoms of severe diarrhoea, foul breath, and significant weight loss over the past few months. Which of the following is the most likely complication he is experiencing?", "options": [{"label": "A", "text": "Gastrocolic fistula", "correct": true}, {"label": "B", "text": "Postvagotomy diarrhoea", "correct": false}, {"label": "C", "text": "Bilious vomiting", "correct": false}, {"label": "D", "text": "Nutritional deficiency", "correct": false}], "correct_answer": "A. Gastrocolic fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrocolic <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">Fistula</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe diarrhoea, foul breath, <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> of faecal material, rapid weight loss, dehydration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CT with oral contrast, <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">barium</span> enema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correct dehydration/nutrition, revisional surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postvagotomy <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhoea, rapid <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying, no foul breath</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical evaluation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dietary management, <span class=\"customMeta\" data-dictid=\"b43084435316927771815e5962f81d\">antidiarrheal</span> agents, <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> ineffective</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">Vomiting</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vomiting <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> and food, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical assessment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bile-chelating agents, Roux-en-Y diversion, revisional surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nutritional <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss, iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia, vitamin B12 deficiency, osteoporosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood tests, clinical evaluation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dietary supplementation, iron and B12 supplements, calcium/vitamin D</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small Stomach Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early satiety, loss of <span class=\"customMeta\" data-dictid=\"22aad956ce1692777197529ede4020\">receptive</span> relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical evaluation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically improves with time; dietary adjustments may help</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potential development of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer 10+ years post-surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic surveillance, <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> if needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular monitoring for early detection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gallstones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be asymptomatic; possibly <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> colic, nausea, vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound, and <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> if symptomatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholecystectomy if symptomatic, but may exacerbate other post-surgery symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dumping Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> and <span class=\"customMeta\" data-dictid=\"bd99ec780c16927772018a45db80c2\">vasomotor</span> symptoms (early), <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> (late)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical evaluation, blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tests</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dietary modification, <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> for severe cases, potential revisional surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Disturbances</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anaemia (iron or B12 deficiency), osteoporosis, osteomalacia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood tests, <span class=\"customMeta\" data-dictid=\"0b2564673b16927771836152f83121\">bone density</span> scans</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iron/B12 supplementation, calcium/vitamin D, and <span class=\"customMeta\" data-dictid=\"8ddb9380a816927772028a1805805e\">fat-soluble vitamins</span> if needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Afferent Loop Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epigastric discomfort, cramping, projectile <span class=\"customMeta\" data-dictid=\"edaa2826da16927771831143fd2b3d\">bilious</span> vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper endoscopy, <span class=\"customMeta\" data-dictid=\"72cf96e6ab16927771970405c5066c\">radionuclide</span> studies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical correction: Billroth I conversion, enteroenterostomy, Roux-en-Y conversion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Efferent Loop Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colicky <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, <span class=\"customMeta\" data-dictid=\"edaa2826da16927771831143fd2b3d\">bilious</span> vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distention</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper GI series, CT with oral contrast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical intervention: reduce hernia, close retro anastomotic space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">Reflux</span> Gastritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epigastric pain, <span class=\"customMeta\" data-dictid=\"edaa2826da16927771831143fd2b3d\">bilious</span> vomiting, weight loss, erythematous <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> on endoscopy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Technetium <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> scan, endoscopy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Roux-en-Y <span class=\"customMeta\" data-dictid=\"b9269d3caf169277718822b07bda96\">gastrojejunostomy</span> conversion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric Atony</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying, fullness, potential <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> outlet obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scintigraphic <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> assessment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dietary management, <span class=\"customMeta\" data-dictid=\"61274f971e1692777196235af20217\">prokinetic</span> agents</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6Tt5VXlsUjRKuy278C8X1745732337.mp3", "video": ""}, {"text": "A 62-year-old woman is diagnosed with a T3N1M0 gastric adenocarcinoma located in the proximal third of the stomach, extending to the gastroesophageal junction. Which of the following gastrectomy procedures is most appropriate for curative intent?", "options": [{"label": "A", "text": "Distal gastrectomy", "correct": false}, {"label": "B", "text": "Proximal gastrectomy", "correct": false}, {"label": "C", "text": "Total gastrectomy", "correct": true}, {"label": "D", "text": "Sleeve gastrectomy", "correct": false}], "correct_answer": "C. Total gastrectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ts5FpDFZdCpP8EuKVU5b1739881164.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Type of Gastrectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Amount of Stomach Removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"60e93bf2cd169277718880e1f2920b\">Gastrectomy</span> </strong></p>\n<p><strong>(</strong>The most appropriate procedure for this patient is<strong> total gastrectomy.)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>100%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Proximal/middle third tumours, <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> type cancers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Extensive (D2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Distal <span class=\"customMeta\" data-dictid=\"60e93bf2cd169277718880e1f2920b\">Gastrectomy</span> (</strong><strong>Option A ruled out)</strong><strong> </strong>It is typically used for tumours located in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> third of the stomach or antrum.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>40-80%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Distal third/antral tumours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>D1 or D2</p>\n<p><strong>D1 </strong>- Involves removal of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> stations 1, 3, 4sb, 4d, 5, 6, and 7.</p>\n<p><strong>D2</strong> - Includes D1 <span class=\"customMeta\" data-dictid=\"27896a100c169277719111d4c4f539\">lymphadenectomy</span> with additional removal of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> stations 8a, 9, 11p, and 12a.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Proximal <span class=\"customMeta\" data-dictid=\"60e93bf2cd169277718880e1f2920b\">Gastrectomy</span> (</strong><strong>Option B ruled out)</strong> is generally reserved for early-stage cancers of the upper third of the stomach that do not involve the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> junction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper third</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Early-stage <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tumours not involving GEJ</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Limited</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sleeve <span class=\"customMeta\" data-dictid=\"60e93bf2cd169277718880e1f2920b\">Gastrectomy</span> (</strong><strong>Option D ruled out)</strong><strong> </strong>is primarily a <span class=\"customMeta\" data-dictid=\"a9d3b38ddb16927771824feedb7ff9\">bariatric</span> procedure and is not used for <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer treatment.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>70-80% (vertical)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not used for cancer treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>N/A</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0Ekol0HuaTDk3lqolL3A1745732076.mp3", "video": ""}, {"text": "A 55-year-old man undergoes a distal gastrectomy for gastric cancer. The surgeon wants to restore gastrointestinal continuity with a method that minimizes bile reflux gastritis. Which of the following reconstruction techniques is most appropriate?", "options": [{"label": "A", "text": "Billroth I", "correct": false}, {"label": "B", "text": "Billroth II", "correct": false}, {"label": "C", "text": "Roux-en-Y gastrojejunostomy", "correct": true}, {"label": "D", "text": "Jejunal interposition", "correct": false}], "correct_answer": "C. Roux-en-Y gastrojejunostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TAPLNew6O0rTa9CSFgBu1739881037.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anastomosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bile <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">Reflux</span> Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Technical Difficulty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physiological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Billroth I</strong></p>\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"60e93bf2cd169277718880e1f2920b\">gastrectomy</span> and gastroduodenostomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastroduodenostomy</p>\n<p>(<strong>Option A</strong><strong>: </strong><strong>Billroth I</strong> method maintains normal food passage but does not effectively prevent <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> reflux.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More physiological</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Araújo, Diana &amp; Cabral, Inês &amp; Vale, Nuno &amp; Amorim, Irina. (2022). Canine &lt;span class=\" data-dictid=\"12347b15191692777188bc86d226e1\"/>Gastric Cancer: Current Treatment Approaches. Veterinary sciences. 9. 10.3390/vetsci9080383. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-b-Partial-gastrectomy-70-of-the-stomach-removed-c-Billroth-I_fig1_362316694\" data-tags=\"\" height=\"479\" src=\"https://image.prepladder.com/content/58mIs3xIWIpb9dWY0cSD1739880777.png\" width=\"500\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Billroth II</strong></p>\n<p><strong>Partial gastrectomy+ gastrojejunostomy, and <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of duodenal stump</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrojejunostomy (loop) (<strong>Option B: Billroth II</strong><strong> </strong>carries a high risk of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> <span class=\"customMeta\" data-dictid=\"7861e10657169277718815c2f42a75\">gastritis</span> due to the proximity of the biliopancreatic secretions to the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> remnant)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less physiological</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Araújo, Diana &amp; Cabral, Inês &amp; Vale, Nuno &amp; Amorim, Irina. (2022). Canine &lt;span class=\" data-dictid=\"12347b15191692777188bc86d226e1\"/>Gastric Cancer: Current Treatment Approaches. Veterinary sciences. 9. 10.3390/vetsci9080383. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-b-Partial-gastrectomy-70-of-the-stomach-removed-c-Billroth-I_fig1_362316694\" data-tags=\"\" height=\"812\" src=\"https://image.prepladder.com/content/HFTexLd62pFFbmxdgcjq1739880847.png\" width=\"500\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Roux-en-Y</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrojejunostomy (Roux limb): <strong>Roux-en-Y gastrojejunostomy</strong> is the most appropriate <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> technique in this case because it effectively minimizes <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> gastritis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less physiological</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Snauwaert, Christophe &amp; Laukens, Pierre &amp; Dillemans, Bruno &amp; Himpens, Jacques &amp; Looze, Danny &amp; Deprez, Pierre &amp; Badaoui, Abdenor. (2015). Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in &lt;span class=\" data-dictid=\"a9d3b38ddb16927771824feedb7ff9\"/>bariatric Roux-en-Y <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> patients. Endoscopy International Open. 3. 10.1055/s-0034-1392108. \" data-hash=\"\" data-license=\"CC BY-NC ND \" data-source=\"https://www.researchgate.net/figure/Roux-en-Y-gastric-bypass-configuration-The-proximal-jejunum-is-divided-distal-to-the_fig1_281197667\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/l7fbEEr90cLu6BE2vhcf1739880901.png\" width=\"500\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jejunal Interposition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrojejunostomy with interposed jejunal segment <strong>(</strong><strong>Option D)</strong><strong> </strong>can reduce <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> reflux, it's technically more challenging and not as effective as Roux-en-Y in preventing <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> gastritis.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More physiological</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"ignis\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Total_gastrectomy_with_Jejunal_interposition.png\" data-tags=\"\" height=\"467\" src=\"https://image.prepladder.com/content/TAPLNew6O0rTa9CSFgBu1739881037.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VWrctlrmWi4cPzjsbZxD1745731776.mp3", "video": ""}, {"text": "A 45-year-old man with refractory peptic ulcer disease is being considered for surgical intervention. Which of the following procedures will most likely preserve the vagal innervation of the gastric antrum and pylorus while reducing acid secretion?", "options": [{"label": "A", "text": "Truncal vagotomy", "correct": false}, {"label": "B", "text": "Selective vagotomy", "correct": false}, {"label": "C", "text": "Truncal vagotomy with antrectomy", "correct": false}, {"label": "D", "text": "Highly selective vagotomy", "correct": true}], "correct_answer": "D. Highly selective vagotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tGJAYvUyrKGAtZD9Ick91739880514.png", "https://image.prepladder.com/content/OY1s0kb4n5c4qfY96QjG1739880551.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Truncal Vagotomy</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Truncal <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">Vagotomy</span> with Antrectomy</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Selective Vagotomy</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Highly Selective Vagotomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nerves Divided</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Left and right <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> above <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> and <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Truncal <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">vagotomy</span> plus removal of the antrum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Main right and left <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Only nerves to the acid-producing portion (all branches to the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> and body) of the stomach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drainage Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Usually required</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Required</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not required</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acid Reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>~50%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>~85%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt;50%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>Variable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ulcer Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>2-7%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>5-10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>2-10%%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Significant side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt;5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iahTRj6Aq7JxBkE2ezBb1745731596.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The given image is of an ulcer, identify the marked structure?", "options": [{"label": "A", "text": "Margin", "correct": false}, {"label": "B", "text": "Edge", "correct": true}, {"label": "C", "text": "Floor", "correct": false}, {"label": "D", "text": "Base", "correct": false}], "correct_answer": "B. Edge", "question_images": ["https://image.prepladder.com/content/3n8GoJsAETkxnp4HVJly1741111534.png"], "explanation_images": ["https://image.prepladder.com/content/PV1RL6iYEdLsFJET3bJi1741111552.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Margin </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outer limit of the ulcer, usually blending into the surrounding skin/mucosa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The border between the margin and the <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> floor, may be raised (malignant), undermined (tuberculous), or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> (syphilitic).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Floor </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The exposed surface inside the ulcer, may contain slough, <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, or necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Base </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The structure beneath the ulcer, which can be soft tissue, bone, or a vessel.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient experiencing excessive bleeding, with limbs displaying low temperature and reduced central venous pressure (CVP), what type of shock is observed?", "options": [{"label": "A", "text": "Cardiogenic shock", "correct": false}, {"label": "B", "text": "Hypovolemic shock", "correct": true}, {"label": "C", "text": "Obstructive shock", "correct": false}, {"label": "D", "text": "Hypo adrenal shock", "correct": false}], "correct_answer": "B. Hypovolemic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6nTSx6ZBX659oD8ShHHt1746976815.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:415px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology of Hypovolemic shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"602\" src=\"https://image.prepladder.com/content/6nTSx6ZBX659oD8ShHHt1746976815.png\" width=\"602\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Physiological Hemodynamic Characteristics of Shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Vascular Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central Venous Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a hypotensive patient with a head injury, which of the subsequent fluids should be avoided?", "options": [{"label": "A", "text": "0.9% NS", "correct": false}, {"label": "B", "text": "5% Dextrose", "correct": true}, {"label": "C", "text": "Ringer lactate", "correct": false}, {"label": "D", "text": "3% saline", "correct": false}], "correct_answer": "B. 5% Dextrose", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 13 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What kind of wound is an open cardiac massage?", "options": [{"label": "A", "text": "Clean", "correct": false}, {"label": "B", "text": "Contaminated", "correct": true}, {"label": "C", "text": "Dirty", "correct": false}, {"label": "D", "text": "Clean Contaminated", "correct": false}], "correct_answer": "B. Contaminated", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hQ9B9jbLi52ab6klq8wk1746182646.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:702px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Class I</strong></p>\n<p><strong>Clean</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>An uninfected <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> wound with <strong>no inflammation</strong> and <strong>no entry</strong> into the respiratory, alimentary, genital, or uninfected <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tracts. Wounds are primarily closed, and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is closed if needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Class II Clean-Contaminated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>An <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> wound where the <strong>respiratory, alimentary, genital, or <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tracts are entered under controlled conditions without unusual contamination.</strong> Includes operations like <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tract, appendix, vagina, and oropharynx.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Class III </strong></p>\n<p><strong>Contaminated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Open, fresh <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> wounds or operations with major breaks in <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> technique </strong></p>\n<p><strong>(open <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> massage)</strong> or <strong>gross spillage from the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract</strong>, with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> non-purulent inflammation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Class IV</strong></p>\n<p><strong>Dirty-Infected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Old <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> wounds with retained devitalized tissue, clinical infection, or <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> viscera.</strong> The organisms causing <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> infection were <strong>already present </strong>in the <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> field before the operation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman, 10 years after mastectomy, notices gradual swelling and heaviness in her right upper limb without pain. On examination, bluish nodules on the skin with no infections are noted. What is the most likely cause of her symptoms?", "options": [{"label": "A", "text": "Lymphangiosarcoma", "correct": true}, {"label": "B", "text": "Thoracic outlet syndrome", "correct": false}, {"label": "C", "text": "Chronic venous insufficiency", "correct": false}, {"label": "D", "text": "Recurrent breast cancer", "correct": false}], "correct_answer": "A. Lymphangiosarcoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Explanations </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphedema </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling is caused by the accumulation of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> fluid in the arm or <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> due to the removal of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.(After MRM and axillary dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wound infection/Flap necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postoperative infections where blackening of <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line is seen (flap necrosis), if necrosed site note removed, leads to wound infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-Mastectomy Pain Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic pain in the chest or upper arm due to nerve damage or <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Long<strong> </strong>thoracic nerve- injury leads to winging of the scapula</li>\n<li>Thoracodorsal nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphangiosarcoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stewart-Treves syndrome</strong> - Cancerous growth in the <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels, often associated with long-standing lymphedema.</li>\n<li>After an average of 10.5 years following MRM and radiotherapy, the patient develops angiosarcoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency room after a road traffic accident with shock and hypotension. The extended focused assessment with sonography for trauma (eFAST) is negative, the X-ray is normal, and the ECG shows no abnormalities. The patient's SpO2 is 93%, blood pressure is 80/60 mmHg, and pulse rate is 40/min. Based on this information, what type of shock is most likely?", "options": [{"label": "A", "text": "Septic shock", "correct": false}, {"label": "B", "text": "Hemorrhagic shock", "correct": false}, {"label": "C", "text": "Cardiogenic shock", "correct": false}, {"label": "D", "text": "Neurogenic shock", "correct": true}], "correct_answer": "D. Neurogenic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Co8IlOErexfVtea2GtPW1747385463.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Central Venous Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients at risk of refeeding syndrome, which of the following electrolyte imbalances is typically not associated with this condition?", "options": [{"label": "A", "text": "Hypokalemia", "correct": false}, {"label": "B", "text": "Hyperkalemia", "correct": true}, {"label": "C", "text": "Hypocalcemia", "correct": false}, {"label": "D", "text": "Hypophosphatemia", "correct": false}], "correct_answer": "B. Hyperkalemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GuKiS5fQ8zKopSMYgPIy1747223474.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>One or more of the following: (OR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Two or more of the following:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BMI &lt;16 kg/m<sup>2</sup></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BMI &lt;18.5 kg/m<sup>2</sup></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unintentional weight loss &gt;15% within the last 3-6 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unintentional weight loss &gt;10% within the last 3-6 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Little or no nutritional <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> for more than 10 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Little or no nutritional <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> for more than 5 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low potassium, <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> or <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> levels prior to feeding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>History of alcohol abuse or on medication, including insulin, chemotherapy, antacids or diuretics.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the edges of the lesion given in the image:", "options": [{"label": "A", "text": "Everted", "correct": false}, {"label": "B", "text": "Rolled out", "correct": true}, {"label": "C", "text": "Sloping", "correct": false}, {"label": "D", "text": "Punched out", "correct": false}], "correct_answer": "B. Rolled out", "question_images": ["https://image.prepladder.com/content/8cNqGZwutSue4NZfM4Qn1747224752.png"], "explanation_images": ["https://image.prepladder.com/content/QrlC1enjl4hTNR7RGK3B1747385636.png", "https://image.prepladder.com/content/Nz2pXpgA7CjLw73K46Gd1747385656.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of edges</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sloping edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Healing ulcer</li>\n<li>Varicose ulcer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inner part: </strong>Red (healthy <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue)</li>\n<li><strong>Middle part:</strong> Blue (epithelial proliferation)</li>\n<li><strong>Outer part: </strong>White (scar/fibrous tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Undermined edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tubercular ulcers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disease process advances in the deeper plane (subcutaneous tissue), whereas (skin) <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> proliferates inwards</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punched out edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arterial / Ischemic ulcers</li>\n<li>Gummatous (syphilitic) ulcer</li>\n<li>Trophic ulcer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to endarteritis</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Raised &amp; <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">beaded</span> edge</strong></p>\n<p><strong>Rolled out / </strong></p>\n<p><strong>Pearly white edge</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rodent ulcer- Basal cell carcinoma</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beads are due to proliferating active cells</p>\n<p> </p>\n<p>Pearly white in appearance</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Everted edge / </strong></p>\n<p><strong>Rolled out edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Squamous cell carcinoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to the spill of proliferating <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tissue over the normal skin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient following a road traffic accident (RTA) with a crush injury presents with crepitus and a reddish-brown wound within 3 days after amputation. What is the most likely condition?", "options": [{"label": "A", "text": "Gas gangrene", "correct": true}, {"label": "B", "text": "Impetigo", "correct": false}, {"label": "C", "text": "Tetanus", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "A. Gas gangrene", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gA2Tc0ReIPfLNB0R2SSg1747225173.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gas <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A rapidly progressive, potentially fatal condition characterized by widespread <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of muscles and soft-tissue destruction, often due to late-presenting missile wounds or crushing injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clostridium perfringens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;24 hours but ranges from 1 hour to 6 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sources and <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated soil and feces.</li>\n<li>Wounds with necrotic or foreign material.</li>\n<li>Crush wounds, road traffic accidents, amputations.</li>\n<li>Anaerobic environments in the wound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adductor region of the <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> and buttocks.</li>\n<li>Subscapular region in the upper limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe pain with limb <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> rapidly increases in severity.</li>\n<li>Serosanguineous discharge.</li>\n<li>Skin turns brown to blue-black with hemorrhagic bullae.</li>\n<li>Sweet, sticky <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> &amp; Soft-tissue crepitus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Septicaemia, toxemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, liver failure.</li>\n<li>Circulatory failure, DIC, secondary infections.</li>\n<li>Death occurs in critically ill patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Gas in soft tissues.</li>\n<li>Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> &amp; blood culture: Large Gram-positive <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> without neutrophils.</li>\n<li>Biochemical profile: Metabolic acidosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Peripheral blood smear: Haemolysis.</li>\n<li>CT scan for chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> and clindamycin, along with 3rd generation cephalosporins, are given intravenously.</li>\n<li>Polyvalent antiserums given intravenously.</li>\n<li>All dead tissues are excised, and debridement is performed until healthy tissue bleeds.</li>\n<li>Amputation done in severe cases</li>\n<li>Hyperbaric oxygen therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proper debridement of devitalized crushed wounds.</li>\n<li>Devitalized wounds should not be sutured.</li>\n<li>Adequate cleaning of wounds with H₂O₂ and normal saline.</li>\n<li>Penicillin - As a <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CNX OpenStax\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:OSC_Microbio_09_02_foot.jpg\" data-tags=\"\" height=\"285\" src=\"https://image.prepladder.com/content/gA2Tc0ReIPfLNB0R2SSg1747225173.png\" width=\"438\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the stages of wound healing in the correct sequence:", "options": [{"label": "A", "text": "Proliferation, hemostasis, inflammation, remodeling", "correct": false}, {"label": "B", "text": "Inflammation, remodeling, hemostasis, proliferation", "correct": false}, {"label": "C", "text": "Hemostasis, inflammation, proliferation, remodeling", "correct": true}, {"label": "D", "text": "Remodeling, proliferation, hemostasis, inflammation", "correct": false}], "correct_answer": "C. Hemostasis, inflammation, proliferation, remodeling", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is considered a “sure sign” of abdominal wound dehiscence in a post-operative hypotensive patient?", "options": [{"label": "A", "text": "Increased bowel sounds", "correct": false}, {"label": "B", "text": "Persistent abdominal pain", "correct": false}, {"label": "C", "text": "Serosanguinous drainage from the wound", "correct": true}, {"label": "D", "text": "Widening of the abdominal scar with palpable edges", "correct": false}], "correct_answer": "C. Serosanguinous drainage from the wound", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly chronic smoker male is diagnosed with squamous cell carcinoma of the lower lip with no lymph node involvement. What is the treatment of choice?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Combined chemoradiotherapy", "correct": false}, {"label": "C", "text": "Wide local excision with negative borders", "correct": false}, {"label": "D", "text": "Wide local excision with frozen section", "correct": true}], "correct_answer": "D. Wide local excision with frozen section", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a triage setting, which of the following categories requires the highest priority intervention?", "options": [{"label": "A", "text": "Red", "correct": true}, {"label": "B", "text": "Yellow", "correct": false}, {"label": "C", "text": "Green", "correct": false}, {"label": "D", "text": "Black", "correct": false}], "correct_answer": "A. Red", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Priority </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medical Need </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Status </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical, but likely to survive if treatment is given early</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> trauma</li>\n<li>Tension pneumothorax</li>\n<li>Profuse external bleeding</li>\n<li>Haemothorax</li>\n<li>Flail chest</li>\n<li>Major <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> bleed</li>\n<li>Extradural haematomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow (Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical, but likely to survive if treatment is given within hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Compound fractures</li>\n<li>Degloving injuries</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscus</li>\n<li>Pelvic fracture</li>\n<li>Spinal injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Green (Option C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stable, likely to survive even if treatment is delayed for hours to days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple fractures</li>\n<li>Sprains</li>\n<li>Minor lacerations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Black (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Last</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unsalvageable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not breathing, pulseless, so severely injured that no medical care is likely to help.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe brain damage</li>\n<li>Very extensive burns</li>\n<li>Major disruption/ loss of chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall structures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of skin graft is used in the image shown?", "options": [{"label": "A", "text": "Split thickness", "correct": true}, {"label": "B", "text": "Full thickness", "correct": false}, {"label": "C", "text": "Wolfe graft", "correct": false}, {"label": "D", "text": "Local flap", "correct": false}], "correct_answer": "A. Split thickness", "question_images": ["https://image.prepladder.com/content/IBRYhGiL28SAxxuIzI4o1747284898.png"], "explanation_images": ["https://image.prepladder.com/content/kuW2DUd284ITkoXgA1a81747386858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Thiersch Graft (Split-Thickness Skin Graft)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wolfe Graft (Full-Thickness Skin Graft)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Skin Grafting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Split-thickness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Full-thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermis + part of dermis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermis + full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large grafts can be taken</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only small grafts can be taken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft Survival</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Easier</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More difficult</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donor Site Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heals spontaneously, allowing repeated grafts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Permanent <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> develops, preventing repeated grafts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft Contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Significant contraction, leading to poor <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lesser contraction, better <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Donor Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inner thigh, upper arm, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> aspect of forearm, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper eyelid, retro <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> skin, <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> skin, <span class=\"customMeta\" data-dictid=\"116f4dd59e169277718172685cecb2\">antecubital</span> skin, <span class=\"customMeta\" data-dictid=\"5f4a18606116927771909db4d0fe2f\">inframammary</span> skin, inguinal skin, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> skin, <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donor Site Exclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Axilla is not used as a donor site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages of Harvesting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"b24aa5ceb516927771836a4cb7dd29\">calibration</span> of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> and large area coverage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calibration of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> for small but thick grafts</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents to the outpatient department 10 days postpartum with complaints of a fluctuant breast mass with tenderness, high-grade fever, and cracked nipples. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Breast engorgement", "correct": false}, {"label": "B", "text": "Breast abscess", "correct": true}, {"label": "C", "text": "Acute mastitis", "correct": false}, {"label": "D", "text": "Fibroadenoma", "correct": false}], "correct_answer": "B. Breast abscess", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess: </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes and Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactation:\n\t\t\t\t<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li>Non-Lactation:\n\t\t\t\t<ul>\n<li>Often in<strong> <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis.</strong></li>\n<li><strong>Smoking and diabetes </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs and symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ultrasonography:\n\t\t\t\t<ul>\n<li>Detects cellulitis, <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision.</li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews, culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li>Non-Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female patient with chronic pancreatitis undergoes a Puestow procedure. What is the most preferred route for supplementary nutrition in this patient?", "options": [{"label": "A", "text": "TPN (Total Parenteral Nutrition)", "correct": true}, {"label": "B", "text": "Oral feeding", "correct": false}, {"label": "C", "text": "Feeding gastrostomy", "correct": false}, {"label": "D", "text": "Feeding jejunostomy", "correct": false}], "correct_answer": "A. TPN (Total Parenteral Nutrition)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>3 in 1 <span class=\"customMeta\" data-dictid=\"cbc39c70db169277720312f2d6905b\">formulation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>2 in 1 formulation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solutions with lipids <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solutions without lipids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>60/20/20</strong></p>\n<ul>\n<li>60% by dextrose</li>\n<li>20% by <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</li>\n<li>20% by fat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>75/25</strong></p>\n<ul>\n<li>75% by dextrose</li>\n<li>25% by <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</li>\n<li>No lipids used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Fiber is absent in both formulations</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Line Insertion Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Pneumothorax (most dangerous)</li>\n<li>Misplacement of catheter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Line-Related Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sepsis (most common)</li>\n<li>Thrombosis (more common with long-term <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> use)</li>\n<li>Electrolyte imbalances (e.g., <span class=\"customMeta\" data-dictid=\"acd4d513d216927771971a62ca95db\">refeeding</span> syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood sugar derangements (hyperglycemia, hypoglycemia)</li>\n<li>Liver dysfunction</li>\n<li>Metabolic bone disease</li>\n<li>Vitamin deficiencies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the incision made and marked in the image.", "options": [{"label": "A", "text": "Robson", "correct": false}, {"label": "B", "text": "Maylard", "correct": false}, {"label": "C", "text": "Gibson Abernathy", "correct": true}, {"label": "D", "text": "Kocher's", "correct": false}], "correct_answer": "C. Gibson Abernathy", "question_images": ["https://image.prepladder.com/notes/JFQ9L3w8r2IQiGPsU92v1746182755.png"], "explanation_images": ["https://image.prepladder.com/notes/uXvZBwfjjQrmWP1BxhSG1746182841.png", "https://image.prepladder.com/notes/LGG792SjvuV9hFkknhR01746182907.png", "https://image.prepladder.com/notes/o8ylyEeMjvyrJGJWAj631746182961.png", "https://image.prepladder.com/notes/874zj5qRASwznxx7n9nc1746183019.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:773px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Incision Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Common Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Abdominal Incisions</strong></p>\n<p><img alt=\"Abdominal Incisions\" data-author=\"\" data-hash=\"11534\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/uXvZBwfjjQrmWP1BxhSG1746182841.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Midline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Longitudinal cut through the <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba, <span class=\"customMeta\" data-dictid=\"1ad3dee7d11692777183c0670e32a1\">bloodless</span> access</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Exploratory laparotomy, trauma surgery, emergency surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Periumbilical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incisions around the umbilicus, avoiding the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> stalk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Laparoscopy, <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repairs, <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> ligation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pararectus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Along the <span class=\"customMeta\" data-dictid=\"7a23f5d3cd16927771982eb39c68c1\">semilunar</span> line, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> abdominis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Abdominal wall <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repairs, <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> creation, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Paramedian</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba, access to <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> viscera</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> structures,</p>\n<p>Reduced <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Kocher/Subcostal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inferior and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"ece2c20c001692777185d9ca0c08db\">costal</span> margin, access to upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Gallbladder, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, pancreas, liver transplants, epigastric surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Gridiron/</strong></p>\n<p><strong>McBurney/</strong></p>\n<p><strong>Lanz</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> incisions, typically for appendectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Appendectomy (right side), <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"c8de4db86c16927771862eeef04df3\">diverticulitis</span> (left side), <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appendectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracoabdominal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>From 7th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space to the umbilicus, exposes <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Retroperitoneal masses, pleural space, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> oesophagus, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracic Incisions</strong></p>\n<p><img alt=\"Thoracic Incisions\" data-author=\"\" data-hash=\"11535\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/LGG792SjvuV9hFkknhR01746182907.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Access to <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> structures, various approaches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lung transplants, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> surgeries, trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Median Sternotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> dividing the sternum, wide access to the mediastinum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Open-heart surgery, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> tumour resection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Trapdoor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Complex incision, supraclavicular, sternal, and <span class=\"customMeta\" data-dictid=\"38764530ef16927772005496ff59a5\">thoracotomy</span> components</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Penetrating trauma, aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> aneurysms, complex <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> access</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Infraclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>A <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> just below the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> for <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessel access</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Thoracic outlet syndrome, <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessel surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Supraclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superior to the clavicle, providing access to the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Trauma, <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Neck Incisions</strong></p>\n<p><img alt=\" Neck Incisions\" data-author=\"\" data-hash=\"11536\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/o8ylyEeMjvyrJGJWAj631746182961.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Collar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incision above the sternal <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> for <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> surgeries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Thyroid surgery, mid-neck structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Traumatic Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Along the <span class=\"customMeta\" data-dictid=\"ebf38dd1b416927771994e550b0d1e\">sternocleidomastoid</span> muscle for trauma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vascular or <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> neck injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Tracheostomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical/horizontal <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> superior to the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> for tracheostomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Airway management in patients needing long-term ventilation</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pelvic Incisions</strong></p>\n<p><img alt=\"Pelvic Incisions\" data-author=\"\" data-hash=\"11537\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"434\" src=\"https://image.prepladder.com/notes/874zj5qRASwznxx7n9nc1746183019.png\" width=\"450\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pfannenstiel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transverse <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> above the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cesarean section, pelvic, urologic, and <span class=\"customMeta\" data-dictid=\"2a73ca8f1b16927771949cec7c59cc\">orthopaedic</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Maylard/Cherney</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> provides access to <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Hysterectomy, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection, lower <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Inguinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair, urologic surgeries (cryptorchidism, varicocele)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>McEvedy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Femoral <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair (obsolete now due to high <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Gibson</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above inguinal ligament, <span class=\"customMeta\" data-dictid=\"2207398c591692777182d7ac096dbc\">arc</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Kidney transplantation, <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> access (iliac vessels, ureter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the test provided in the image below.", "options": [{"label": "A", "text": "Allen’s test", "correct": true}, {"label": "B", "text": "Adson’s test", "correct": false}, {"label": "C", "text": "Elevated arm stress test", "correct": false}, {"label": "D", "text": "Nicoladoni’s test", "correct": false}], "correct_answer": "A. Allen’s test", "question_images": ["https://image.prepladder.com/notes/5vpVEwLqgLUdSyuLKRJT1746183131.png"], "explanation_images": ["https://image.prepladder.com/content/00XNUwzsB9oVo7V2FDIn1745989365.png", "https://image.prepladder.com/notes/UjKkmjym3IMHcXdshQvl1746183198.png", "https://image.prepladder.com/content/iNWqTfLXEVk57l313VKZ1745989365.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Smoking increases the risk of which of the following diseases? Duct ectasia Fibroadenoma Mondor disease Breast carcinoma", "options": [{"label": "A", "text": "2, 3", "correct": false}, {"label": "B", "text": "1, 4", "correct": false}, {"label": "C", "text": "2, 3, 4", "correct": false}, {"label": "D", "text": "1, 3, 4", "correct": true}], "correct_answer": "D. 1, 3, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Modifiable risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Non-modifiable risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obesity: <span class=\"customMeta\" data-dictid=\"765e9149d01692777183c3989c6590\">BMI</span> &gt; 30 (RR= 1.29)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n<ul>\n<li>Median age at presentation is 60 years in the West(UK, USA), While it is around 48 years in low/middle-income nations such as India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nulliparous women or first pregnancy after 35 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sex</strong></p>\n<ul>\n<li>Female sex is a risk factor</li>\n<li>Male sex accounts for 0.5-1% of all breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Breastfeeding is a protective factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ethnicity</strong></p>\n<p><strong>American white, African-American Parsi in India</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Use of Hormonal Replacement Therapy (HRT) &gt;10 years (RR= 1.2)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Family history of breast cancer</strong></p>\n<ul>\n<li>1 first-degree relative RR= 2</li>\n<li>2 first-degree relative RR= 3</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tobacco use (RR=1.07-1.14)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic predisposition</strong></p>\n<p>BRCA1 and BRCA2 mutations account for 70% of <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> breast cancers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alcohol Consumption (RR = 1.05-1.32)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early Menarche(&lt;12years)</strong></p>\n<p>Increases by around 5% for each year earlier <span class=\"customMeta\" data-dictid=\"af76284ec71692777192c7c84b5dad\">menstruation</span> begins RR=1.19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radiation exposure (RR=6)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Late Menopause(&gt;55years)</strong></p>\n<p>Increases by about 3% for each year later <span class=\"customMeta\" data-dictid=\"516cc2e77d169277719213e7926b59\">menopause</span> begins RR=1.12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Age at first child</p>\n<p> </p>\n<ul>\n<li>&lt;20years - Less risk</li>\n<li>&gt;35years - High risk</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-risk breast lesions</strong></p>\n<ul>\n<li>Complex <span class=\"customMeta\" data-dictid=\"633e6ef4ca169277720219ea037f2c\">fibroadenoma</span> RR=3</li>\n<li>Papillomatosis RR=3</li>\n<li>Ductal and lobular <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> RR= 5</li>\n<li>Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> RR= 8-10</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male patient is brought to the casualty after a road traffic accident (RTA) with suspected pelvic fractures. On examination, he is found to be in hypovolemic shock. What is the earliest treatment for control of haemorrhage in this case?", "options": [{"label": "A", "text": "Immediate internal fixation", "correct": false}, {"label": "B", "text": "Multiple blood transfusions", "correct": false}, {"label": "C", "text": "Use bedsheets to compress the pelvis", "correct": true}, {"label": "D", "text": "Emergency external fixation", "correct": false}], "correct_answer": "C. Use bedsheets to compress the pelvis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/O3WVxP4o2adbeNT1v2jL1746183310.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A soldier arrives at a referral hospital 24 hours after experiencing a shrapnel injury to his right thigh caused by a high-speed projectile. He expresses significant discomfort at the site of the wound. Upon examination, there is evidence of crepitus. Which of the following microorganisms is the probable culprit behind his current state?", "options": [{"label": "A", "text": "Clostridium septicum", "correct": false}, {"label": "B", "text": "Clostridium difficile", "correct": false}, {"label": "C", "text": "Clostridium novyi", "correct": false}, {"label": "D", "text": "Clostridium perfringens", "correct": true}], "correct_answer": "D. Clostridium perfringens", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IRFjpSNnDnNTbh0dlljz1746167891.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A rapidly progressive, potentially fatal condition characterized by widespread <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of muscles and soft-tissue destruction, often due to late-presenting missile wounds or crushing injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clostridium perfringens<strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;24 hours but ranges from 1 hour to 6 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sources and <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated soil and feces.</li>\n<li>Wounds with necrotic or foreign material.</li>\n<li>Crush wounds, road traffic accidents, amputations.</li>\n<li>Anaerobic environments in the wound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adductor region of the <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> and buttocks.</li>\n<li>Subscapular region in the upper limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe pain with limb <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> rapidly increases in severity.</li>\n<li>Serosanguineous discharge.</li>\n<li>Skin turns brown to blue-black with hemorrhagic bullae.</li>\n<li>Sweet, sticky <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> &amp; Soft-tissue <span class=\"customMeta\" data-dictid=\"2483707fe9169277718541a169f5b4\">crepitus</span> (presence of gas in the tissues).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Septicaemia, toxemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, liver failure.</li>\n<li>Circulatory failure, DIC, secondary infections.</li>\n<li>Death occurs in critically ill patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Gas in soft tissues.</li>\n<li>Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> &amp; blood culture: Large Gram-positive <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> without neutrophils.</li>\n<li>Biochemical profile: Metabolic acidosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Peripheral blood smear: Haemolysis.</li>\n<li>CT scan for chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> and clindamycin, along with 3rd generation cephalosporins, are given intravenously.</li>\n<li>Polyvalent antiserums given intravenously.</li>\n<li>All dead tissues are excised, and debridement is performed until healthy tissue bleeds.</li>\n<li>Amputation done in severe cases</li>\n<li>Hyperbaric oxygen therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proper debridement of devitalized crushed wounds.</li>\n<li>Devitalized wounds should not be sutured.</li>\n<li>Adequate cleaning of wounds with H₂O₂ and normal saline.</li>\n<li>Penicillin - As a <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Heather Murphy-Lavoie\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Gas_gangrene2.jpg#/media/File:Gas_gangrene2.jpg\" data-tags=\"\" height=\"469\" src=\"https://image.prepladder.com/content/IRFjpSNnDnNTbh0dlljz1746167891.png\" width=\"262\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female undergoes emergency laparotomy for perforation peritonitis. Which of the following is the surest sign of wound dehiscence?", "options": [{"label": "A", "text": "Copious sero-sanguinous discharge", "correct": true}, {"label": "B", "text": "Rebound tenderness", "correct": false}, {"label": "C", "text": "Hemorrhage", "correct": false}, {"label": "D", "text": "Hypotension", "correct": false}], "correct_answer": "A. Copious sero-sanguinous discharge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Yz1a40tLyEl6RTSjftyp1746171355.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Disruption of any or all of the layers in a wound.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occurrence </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 3% of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds; most commonly occurs between the 5th and 8th <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Partial dehiscence:</strong> Involves only the skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat.</li>\n<li><strong>Complete dehiscence: </strong>Involves the fascial layer and may include <span class=\"customMeta\" data-dictid=\"00fc1a6b38169277718780d2bc69d1\">evisceration</span> (extrusion of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscera).</li>\n</ol>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"585\" src=\"https://image.prepladder.com/content/Yz1a40tLyEl6RTSjftyp1746171355.png\" width=\"545\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General:</strong></p>\n<ul>\n<li>Malnourishment</li>\n<li>Diabetes</li>\n<li>Obesity</li>\n<li>Renal failure</li>\n<li>Jaundice</li>\n<li>Sepsis</li>\n<li>Cancer</li>\n<li>Treatment with steroids</li>\n<li>Emergency surgery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Local:</strong></p>\n<ul>\n<li>Inadequate or poor <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of wound or <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of a wound under tension</li>\n<li>Poor local wound healing</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> pressure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pinkish serosanguinous <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (salmon-coloured fluid), <strong>(Option A)</strong></li>\n<li>Possible evisceration,</li>\n<li>Popping sensation during straining or coughing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Partial <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> (without evisceration): </strong>Prompt reclosure of the <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> is generally advised.</li>\n<li><strong>Complete <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> with evisceration:</strong>\n<ul>\n<li>Requires urgent reoperation.</li>\n<li>Tension suturing is done.</li>\n<li>Protect eviscerated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> with moist towels; handle carefully to prevent injury.</li>\n<li>Antibiotic therapy; fluid management.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the next course of action in the management of a 30-year-old breastfeeding mother who is experiencing pain and fever in her left breast? The left breast appears abnormal as depicted in the provided image. There is slight swelling of the lymph nodes in the armpit on the affected side, while the opposite breast appears normal. Despite multiple attempts at draining the fluid with the use of antibiotics, it was unsuccessful. An ultrasound examination revealed the presence of fluid collection.", "options": [{"label": "A", "text": "Incision an drainage", "correct": true}, {"label": "B", "text": "Broad spectrum antibiotics only", "correct": false}, {"label": "C", "text": "Breast conservation surgery", "correct": false}, {"label": "D", "text": "Punch biopsy", "correct": false}], "correct_answer": "A. Incision an drainage", "question_images": ["https://image.prepladder.com/content/G86RtcUZnYwhdaIKdp0L1691235977.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A barber aged 42 years presented with a healed ulcer as below, over the lower medial aspect of the right leg. On examination, he has varicose veins on both his legs. What is the most likely type of ulcer he had?", "options": [{"label": "A", "text": "Neuropathic ulcer", "correct": false}, {"label": "B", "text": "Arterial ulcer", "correct": false}, {"label": "C", "text": "Venous ulcer", "correct": true}, {"label": "D", "text": "Tubercular ulcer", "correct": false}], "correct_answer": "C. Venous ulcer", "question_images": ["https://image.prepladder.com/content/wCsFvw59dLRFGmQai0cS1747114580.png"], "explanation_images": ["https://image.prepladder.com/content/em8o2chIWf7TGSrXwxhz1747114899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Venous ulcer</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Arterial ulcer</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neuropathic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pressure ulcer</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gaiter’s area</strong> (area between <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> and calf)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ends of limbs, such as toes, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> and legs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over toe joints, under the heel, over malleoli, under the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> head, etc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen over pressure points, most common are ischium, greater trochanter, sacrum, hee, malleolus, occiput, etc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vertically <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> with a sloping edge and will not penetrate deep fascia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punched-out edges </strong>are seen in this type of ulcer.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcers can be associated with <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> and abscesses; <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> can be seen here.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Punched out <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with<strong> bone as a base.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> due to <strong>varicose veins.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This occurs due to severe arterial <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> of digital and medium-sized arteries, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and tissue death in the region.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is caused due to repeated trauma and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> due to <strong>microangiopathy</strong> in <strong>diabetic patients</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> due to prolonged pressure on any part of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is initially painful, then chronically becomes painless.</p>\n<p>It heals on rest and treatment but reforms again.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is intensely painful, and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses are not palpable, and associated with shiny skin, <span class=\"customMeta\" data-dictid=\"e30073048816927771830d431eabfe\">brittle</span> nails and loss of hair over the region.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is also known as <strong>diabetic ulcer</strong> since it is seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is common in bedridden patients with head injuries, neurological deficits, and <span class=\"customMeta\" data-dictid=\"60dcb15b7616927771846fa5872355\">comatose</span> and stroke-ridden patients.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"938\" src=\"https://image.prepladder.com/content/em8o2chIWf7TGSrXwxhz1747114899.png\" width=\"938\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "False regarding deep second-degree burns:", "options": [{"label": "A", "text": "Heal by scar deposition", "correct": false}, {"label": "B", "text": "No blanching", "correct": false}, {"label": "C", "text": "Damage to the deeper dermis", "correct": false}, {"label": "D", "text": "Painless", "correct": true}], "correct_answer": "D. Painless", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Deep Partial-Thickness Burns</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidermis and <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> (bottom layer of dermis) (Option C ruled out).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painful</li>\n<li>Loss of epidermis</li>\n<li>Less moist dermis</li>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> staining</li>\n<li>Reduced sensation</li>\n<li>No blanching with pressure <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Takes<strong> 3+ weeks</strong>: often leads to <strong>scarring (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May require <strong>surgical intervention</strong> (e.g., skin grafting)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis based on the image below?", "options": [{"label": "A", "text": "Botryomycosis", "correct": false}, {"label": "B", "text": "Erysipelas", "correct": false}, {"label": "C", "text": "Ecthyma", "correct": false}, {"label": "D", "text": "Carbuncle", "correct": true}], "correct_answer": "D. Carbuncle", "question_images": ["https://image.prepladder.com/content/xZ4CbcUq22SRWli99FaV1747123032.png"], "explanation_images": ["https://image.prepladder.com/content/mY4ZXhjdqt3fh1xiQKcD1747123070.png", "https://image.prepladder.com/content/RumVylNEUCv619LcHixD1748163373.png", "https://image.prepladder.com/content/cxz0c1grlOtXi6sHGVgz1747123070.png", "https://image.prepladder.com/content/Zk1YHBzfsHRfGPScw5XT1748163399.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Carbuncle </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Infection of hair follicles extending into surrounding and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Staphylococcus aureus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Nape of neck, back.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Red, painful nodule; tender, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> lesion; multiple draining sinuses;</strong> fever, lymphadenopathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Septicemia, abscess, necrosis, requiring possible <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or skin graft.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Control of diabetes; antibiotics; drainage, debridement, possible excision.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Medicalpal,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Carbuncle.jpg\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/mY4ZXhjdqt3fh1xiQKcD1747123070.png\" width=\"566\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ideal pressure setting for vacuum-assisted closure (VAC) therapy?", "options": [{"label": "A", "text": "-125 mm Hg", "correct": true}, {"label": "B", "text": "60 to 80 mm Hg", "correct": false}, {"label": "C", "text": "130 mm Hg", "correct": false}, {"label": "D", "text": "80 to 100 mm Hg", "correct": false}], "correct_answer": "A. -125 mm Hg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 125 mm Hg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 84-year-old man who had a stroke 2 years ago and has been on extended bed rest, develops a pressure ulcer with partial skin thickness loss and a clean base. What is the grade of his pressure sore?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HPCnaspc2nhdWDHmrb0W1741234222.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:683px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pressure <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> stages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non <span class=\"customMeta\" data-dictid=\"79f30e93e41692777183d60fdfa512\">blanchable erythema</span> of the skin, without breach in the epidermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial thickness, less including <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early deep ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Full-thickness skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues but not through underlying fascia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late deep ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Full-thickness skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue, muscle, bone, joints or tendon.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"917\" src=\"https://image.prepladder.com/content/HPCnaspc2nhdWDHmrb0W1741234222.png\" width=\"1999\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male had surgery for an ileal perforation. Due to significant contamination, only the sheath was sutured, leaving the wound open. Daily wound irrigation was carried out, and the wound was closed on postoperative day 5. What type of wound-healing mechanism is occurring in this scenario?", "options": [{"label": "A", "text": "Primary intention", "correct": false}, {"label": "B", "text": "Secondary intention", "correct": false}, {"label": "C", "text": "Tertiary intention", "correct": true}, {"label": "D", "text": "Quaternary intention", "correct": false}], "correct_answer": "C. Tertiary intention", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/19vDl3rya7lNMvXwnK201741234356.png", "https://image.prepladder.com/content/KWpl5ouvLF2DaKqm9kOz1741234367.png", "https://image.prepladder.com/content/070AE8RgC4JrwZRslh681741234324.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Wound healing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Healing by primary intention</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It occurs when the edges of a clean wound are brought together and secured with sutures, staples, or adhesives. Minimal <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> occurs.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/19vDl3rya7lNMvXwnK201741234356.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Healing by secondary intention</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The wound is left open to heal by granulation, contraction, and epithelialisation. This is common in wounds with significant tissue loss or contamination.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/KWpl5ouvLF2DaKqm9kOz1741234367.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Healing by <span class=\"customMeta\" data-dictid=\"22e8a6f65016927772003e97740ab2\">tertiary</span> intention (delayed primary closure)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The wound is initially left open and then closed surgically after several days when it's clean and granulating. This is used for contaminated wounds to prevent infection.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/070AE8RgC4JrwZRslh681741234324.png\" width=\"1999\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A friend of yours is teaching you about enhanced recovery after surgery. Which of the following statements he makes is inaccurate?", "options": [{"label": "A", "text": "Prolonged fasting is necessary", "correct": true}, {"label": "B", "text": "Epidural anaesthesia recommended in laparoscopic surgery for pain control", "correct": false}, {"label": "C", "text": "Reduction of hospital stay by 2-3 weeks", "correct": false}, {"label": "D", "text": "Beta-blockers are given after major surgery done under general anaesthesia to improve the outcome", "correct": false}], "correct_answer": "A. Prolonged fasting is necessary", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During laparoscopic surgery, where shouldn't the trocar be inserted?", "options": [{"label": "A", "text": "Superior epigastric artery", "correct": false}, {"label": "B", "text": "Inferior epigastric artery", "correct": false}, {"label": "C", "text": "Abdominal aorta", "correct": false}, {"label": "D", "text": "Both A and B", "correct": true}], "correct_answer": "D. Both A and B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trocar Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At Risk Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precautions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Umbilical (Primary)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insert at <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supraumbilical (Upper Trocar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior Epigastric Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoid midline <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infraumbilical/Midclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior Epigastric Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insert <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmar’s Point (LUQ Trocar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in difficult access cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient was brought to the emergency department following a road traffic accident.O/E, he had multiple injuries all over his body and was found to be in class III hemorrhagic shock. The percentage of blood loss would be between:", "options": [{"label": "A", "text": "5-15%", "correct": false}, {"label": "B", "text": "30-40%", "correct": true}, {"label": "C", "text": "&amp;gt;40%", "correct": false}, {"label": "D", "text": "15-30%", "correct": false}], "correct_answer": "B. 30-40%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class I (Compensated Shock)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class II (Hypoxemia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class IV (Refractory Shock)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 15%<strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30% <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40%<strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 40%<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compensatory mechanisms maintain <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized vasoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decompensated shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;100/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-120/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>120-140/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;140/min</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-15 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mental Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert, normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anxious, mildly agitated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused, altered mental status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comatose, lethargic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "5", "correct": false}, {"label": "B", "text": "6", "correct": true}, {"label": "C", "text": "7", "correct": false}, {"label": "D", "text": "8", "correct": false}], "correct_answer": "B. 6", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pupil Reactivity Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents to the outpatient department with a swelling on his wrist. He reports fluctuation in size , mild numbness in the hand , and occasional pain . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lipoma", "correct": false}, {"label": "B", "text": "Ganglion cyst", "correct": false}, {"label": "C", "text": "Dermoid cyst", "correct": true}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "C. Dermoid cyst", "question_images": ["https://image.prepladder.com/content/gqjIclGrXM8GneTDx6Nq1741106569.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<th><strong>Condition</strong></th>\n<th><strong>Characteristics</strong></th>\n<th><strong>Pain</strong></th>\n<th><strong>Fluctuation in Size</strong></th>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Numbness</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Lipoma</strong></td>\n<td>Soft, mobile, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat mass</td>\n<td>No</td>\n<td>No</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td><strong>Ganglion cyst</strong></td>\n<td>Fluid-filled, over joint or <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> sheath, translucent</td>\n<td>Occasional</td>\n<td>Yes</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td><strong>Dermoid cyst</strong></td>\n<td>Congenital, contains ectodermal elements (hair/sebum)</td>\n<td>Rare</td>\n<td>Rare</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Hematoma</strong></td>\n<td>Post-trauma, discoloured, self-resolving</td>\n<td>Yes (initially)</td>\n<td>No</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman, a few weeks after delivery, complains of bloody discharge from nipple and fever. On examination, diffuse lump under areola. What is the diagnosis?", "options": [{"label": "A", "text": "Galactocele", "correct": false}, {"label": "B", "text": "Lactational mastitis", "correct": true}, {"label": "C", "text": "Mondor disease", "correct": false}, {"label": "D", "text": "Fibrocystic disease", "correct": false}], "correct_answer": "B. Lactational mastitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactational Mastitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial infection due to milk <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> (commonly <em>Staphylococcus aureus</em>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breastfeeding, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> trauma (cracks), poor latch, prolonged engorgement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, malaise, <strong>painful swollen breast</strong>, erythema, <strong>bloody or <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tender <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> mass</strong>, warmth, <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> over the affected breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breast <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> (if untreated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent breastfeeding, warm compress, analgesics, <strong>antibiotics (dicloxacillin, cephalexin)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with dilated tortuous veins of the leg presented to the OPD and is diagnosed with varicose vein of grade C4a. What is the best preferred treatment?", "options": [{"label": "A", "text": "Compression", "correct": false}, {"label": "B", "text": "Endothermal ablation", "correct": true}, {"label": "C", "text": "Non endothermal non tumescent ablation", "correct": false}, {"label": "D", "text": "Open surgery", "correct": false}], "correct_answer": "B. Endothermal ablation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CEAP Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No visible/palpable signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Telangiectasias or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative (compression)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varicose veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression, ablation, or surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Edema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal ablation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pigmentation/eczema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endothermal ablation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipodermatosclerosis or <span class=\"customMeta\" data-dictid=\"b04fb2c703169277718295309e32d6\">atrophie</span> blanche</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal or open surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> + <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multimodal therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The ureter is safe in which type of hysterectomy?", "options": [{"label": "A", "text": "Open laparotomy", "correct": false}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "Robotic", "correct": false}, {"label": "D", "text": "Vaginal", "correct": true}], "correct_answer": "D. Vaginal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hysterectomy Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ureteric Injury Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reasons</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct ureteric handling, risk during ligation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk due to <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> and <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Robotic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate to high</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> but better visualization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lowest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal ureteric dissection, lower risk of injury</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the grade of the condition given in the image below ?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": false}, {"label": "D", "text": "Grade 4", "correct": true}], "correct_answer": "D. Grade 4", "question_images": ["https://image.prepladder.com/content/ODOgGHyTvDAsiJC3b8nw1724850417.png"], "explanation_images": ["https://image.prepladder.com/content/anwVJpHL60gRf0iuPMqC1724850431.png", "https://image.prepladder.com/content/VnsXYMAF9YnMtrtwGLj91724850443.png", "https://image.prepladder.com/content/GycEf6jMWmjZ145MROfd1724850465.png", "https://image.prepladder.com/content/BZ7u6Uu9MYEc09qkOzXE1724850480.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\"&gt;Grade&lt;/span&gt; 4\n<table align=\"left\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage II</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage III</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage IV</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"6\" style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Non <span class=\"customMeta\" data-dictid=\"79f30e93e41692777183d60fdfa512\">blanchable erythema</span> of skin without breach in epidermis</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</li>\n</ul>\n</td>\n<td colspan=\"1\" rowspan=\"6\" style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> less including <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + dermis.</li>\n<li>Late <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</li>\n</ul>\n</td>\n<td colspan=\"1\" rowspan=\"6\" style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> through underlying fasica.</li>\n<li>Early deep ulcer</li>\n</ul>\n</td>\n<td colspan=\"1\" rowspan=\"6\">\n<ul>\n<li>Full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue, muscle tendon.</li>\n<li>Late deep ulcer</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male with a history of a road traffic accident presents to the emergency department. His GCS is 8/15, oxygen saturation is 85%, blood pressure is 100/60 mmHg and heart rate is 60 beats per minute. On examination, breath sounds are absent on the right side. What is the next step in management?", "options": [{"label": "A", "text": "Start IV fluids, give atropine and secure airway", "correct": false}, {"label": "B", "text": "Secure airway, give oxygen, insert ICD, secure IV line", "correct": true}, {"label": "C", "text": "Evaluate for head injury and do CT-head", "correct": false}, {"label": "D", "text": "Administer IV dextrose followed by NCCT head", "correct": false}], "correct_answer": "B. Secure airway, give oxygen, insert ICD, secure IV line", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old chronic alcoholic presents with severe hematemesis. An ultrasound (USG) shows distention of the portal vein, and the liver appears hyperechoic. Pantoprazole has been administered. What is the next appropriate step in management?", "options": [{"label": "A", "text": "Initiate a course of broad-spectrum antibiotics", "correct": false}, {"label": "B", "text": "Order a liver biopsy to assess for fibrosis", "correct": false}, {"label": "C", "text": "Administer intravenous fluids and electrolyte replacement", "correct": true}, {"label": "D", "text": "Perform an endoscopy to look for varices", "correct": false}], "correct_answer": "C. Administer intravenous fluids and electrolyte replacement", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Administer &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;intravenous&lt;/span&gt; fluids and &lt;span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\"&gt;electrolyte&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a complication of Total Parenteral Nutrition (TPN) in a sepsis patient in the ICU?", "options": [{"label": "A", "text": "Hyperlipidemia", "correct": false}, {"label": "B", "text": "Hyperglycemia", "correct": true}, {"label": "C", "text": "Hyperglyceridemia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": false}], "correct_answer": "B. Hyperglycemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Hyperg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is characteristic of hypovolemic shock?", "options": [{"label": "A", "text": "Increase in cardiac output", "correct": false}, {"label": "B", "text": "High vascular resistance", "correct": true}, {"label": "C", "text": "Increase in venous pressure", "correct": false}, {"label": "D", "text": "Increased mixed venous saturation", "correct": false}], "correct_answer": "B. High vascular resistance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>↑</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of ulcer shown in the image below:", "options": [{"label": "A", "text": "Venous ulcer", "correct": false}, {"label": "B", "text": "Malignant ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": false}, {"label": "D", "text": "Trophic ulcer", "correct": true}], "correct_answer": "D. Trophic ulcer", "question_images": ["https://image.prepladder.com/notes/h2bJCv7N5KPlxwWmqqwK1747643811.png"], "explanation_images": ["https://image.prepladder.com/content/NJoeV6HxnfN2QmgVSS141747293039.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lesion Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ischemic/Arterial</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smoking, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular edges, poor <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, dry necrotic base; round or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> with sharp demarcation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe, particularly at night; relieved by dependency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varicose veins, DVT, trauma, surgery, multiple pregnancies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shallow, irregular/shaggy shape, granulating base, fibrinous material with moderate to heavy exudate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild; relieved by elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurotrophic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Numbness, paresthesias, burning, loss of sensation in the foot, DM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Punched-out, deep sinus, variable depth partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> to severe, involving the tendon, fascia, joint capsule, or bone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignant Ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>History of skin cancer (e.g., <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> or <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular, raised borders, ulcerating tumor with hard, <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often painful, can be associated with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or foul odor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female who is receiving cyclosporine A following renal transplantation develops multiple and bilateral breast lumps that regress after cessation of the treatment. Biopsy image is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Fat necrosis", "correct": false}, {"label": "B", "text": "Phyllodes tumour", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": true}, {"label": "D", "text": "Carcinoma breast", "correct": false}], "correct_answer": "C. Fibroadenoma", "question_images": ["https://image.prepladder.com/content/xxpFYBP2D1CZwhUurGry1747296370.png"], "explanation_images": ["https://image.prepladder.com/content/FqIacfDGYXHyuGYcvZD51747296408.png", "https://image.prepladder.com/content/HY4mAdJNrUoOXMDINIFF1747296424.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents to the outpatient department with a swelling in the back of his neck that has been present for almost a year. The swelling has not increased in size. On examination, it is non-pulsatile, and the slip sign is positive, with the swelling measuring 3x3 cm. Which of the following statements is most likely true?", "options": [{"label": "A", "text": "High chances of malignant transformation", "correct": false}, {"label": "B", "text": "FNAC necessary for diagnosis", "correct": false}, {"label": "C", "text": "PET scan necessary for staging", "correct": false}, {"label": "D", "text": "Excision can be done if the patient requests it", "correct": true}], "correct_answer": "D. Excision can be done if the patient requests it", "question_images": ["https://image.prepladder.com/content/9uuVKtEkiaK2iZk7KKFv1747297886.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old man presents with a chronic non-healing painless ulcer over his scalp for 8 years. He has a history of electric burns to the scalp 8 years ago. The examination findings are shown below. Which of the following statements is true?", "options": [{"label": "A", "text": "Radiotherapy is useful", "correct": false}, {"label": "B", "text": "It can progress to squamous cell carcinoma", "correct": true}, {"label": "C", "text": "No lymphatic spread", "correct": false}, {"label": "D", "text": "Long-duration antibiotics will improve the condition.", "correct": false}], "correct_answer": "B. It can progress to squamous cell carcinoma", "question_images": ["https://image.prepladder.com/notes/jBVCG6v1u6eRWFagdPuL1747645567.png"], "explanation_images": ["https://image.prepladder.com/content/Lg0GJY6UXnzBBmviZRyZ1747301881.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Marjolin’s Ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low-grade <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">Squamous</span> Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (SCC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Post-burn scar</li>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> due to trauma</li>\n<li>Chronic discharging <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> sinus</li>\n<li>Post-radiation ulcer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Develops in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue due to chronic irritation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless (no nerves in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissues)</li>\n<li>Slow growing</li>\n<li>No regional LN <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (no lymphatics in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation of Choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> followed by a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> cover</li>\n<li><strong>Radiotherapy should be avoided (Option A)</strong> (as it is radio-resistant and also to prevent obliterative end arteritis)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents with severe pain and swelling in her right hand, which is increasing in size and severity. She had a prick injury in the garden 5 days ago. On examination, she cries out in pain when her hand is extended and when the palmar aspect is palpated passively. Which of the following statements is true about the condition?", "options": [{"label": "A", "text": "More common in the dorsal aspect of the hand", "correct": false}, {"label": "B", "text": "X-ray imaging will aid in the location of the foreign body in all patients", "correct": false}, {"label": "C", "text": "It requires incision and drainage", "correct": true}, {"label": "D", "text": "Oral analgesics are the mainstay of treatment", "correct": false}], "correct_answer": "C. It requires incision and drainage", "question_images": ["https://image.prepladder.com/notes/SdIsY4pwQkK3iLDAUt3F1747645681.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient fell from a train onto the railway track and injured both his legs severely. He was urgently taken to the hospital, and the following procedure was performed (image shown below). What is the rationale for performing this procedure?", "options": [{"label": "A", "text": "Better fit for prosthesis", "correct": false}, {"label": "B", "text": "Life-saving procedure", "correct": true}, {"label": "C", "text": "Reduces risk of cancer", "correct": false}, {"label": "D", "text": "Good cosmetic outcomes", "correct": false}], "correct_answer": "B. Life-saving procedure", "question_images": ["https://image.prepladder.com/notes/ncf24aC4rL5LKP14TFtO1747648569.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In solid organ transplantation, which of the following organs is associated with a higher incidence of rejection?", "options": [{"label": "A", "text": "Lungs", "correct": true}, {"label": "B", "text": "Intestine", "correct": false}, {"label": "C", "text": "Kidney", "correct": false}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "A. Lungs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 56 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient is brought to the trauma unit after being assaulted. He presents with severe pain, swelling, and deformity in the lower jaw. Imaging confirms a \"bucket handle\" fracture of the mandible. What is the most likely nerve to be injured in this type of fracture?", "options": [{"label": "A", "text": "Lingual nerve", "correct": false}, {"label": "B", "text": "Inferior alveolar nerve", "correct": true}, {"label": "C", "text": "Hypoglossal nerve", "correct": false}, {"label": "D", "text": "Facial nerve", "correct": false}], "correct_answer": "B. Inferior alveolar nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closed Reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-displaced or minimally displaced fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"1f2df5ce8d169277719040b52186aa\">intermaxillary</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (MMF) for stabilization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open Reduction and Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> (ORIF)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Displaced fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical realignment and <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> using plates/screws.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UhmveuuvNhE4mPCaFl081747831103.mp3", "video": ""}, {"text": "Match the following LeFort’s fracture types: LeFort’s types Features 1. LeFort’s I a- Craniofacial dislocation 2. LeFort’s II b- Horizontal fracture 3. LeFort’s III c- Pyramidal fracture d- Tripod fracture", "options": [{"label": "A", "text": "1-b, 2-c, 3-a", "correct": true}, {"label": "B", "text": "1-d, 2-b, 3-a", "correct": false}, {"label": "C", "text": "1-c, 2-d, 3-b", "correct": false}, {"label": "D", "text": "1-a, 2-c, 3-b", "correct": false}], "correct_answer": "A. 1-b, 2-c, 3-a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pod5uEnuhTfm2VU4aRLC1740041724.png", "https://image.prepladder.com/content/GYzYjcymWFretkzlRiVx1740041765.png", "https://image.prepladder.com/content/5stIivzVxEyYcYMoQ3ls1740041803.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LeFort’s types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LeFort’s I</strong></p>\n<p>(Horizontal fracture/ floating fracture)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture line runs horizontally above the floor of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity.</li>\n<li>Separates <span class=\"customMeta\" data-dictid=\"943b7cdefe1692777181b397779312\">alveolus</span> and <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> from <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> skeleton</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"na\" data-hash=\"\" data-license=\"na\" data-source=\"na\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/pod5uEnuhTfm2VU4aRLC1740041724.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LeFort’s II</strong></p>\n<p>(Pyramidal fracture)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture line passes through:</li>\n<li>Nose, <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> bone, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> floor, maxillary sinus, <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plate</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/GYzYjcymWFretkzlRiVx1740041765.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LeFort’s III</strong></p>\n<p>(Craniofacial dislocation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the skull to skull base.</li>\n<li>It passes through the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge, septum, <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> bone, <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> bone, orbit, <span class=\"customMeta\" data-dictid=\"754dd6f02e16927771965a05dd4e22\">pterygomaxillary</span> <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"65363ac32f16927772030370304d8d\">frontozygomatic</span> suture</li>\n<li><strong>NSE of Z</strong> (mnemonic)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/5stIivzVxEyYcYMoQ3ls1740041803.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1ldXzCrykSFFdhx5Qsoy1748345171.mp3", "video": ""}, {"text": "A 30-year-old male presents to the emergency department after a motor vehicle accident. On assessment, there is bruising around the left eye, and tenderness over the zygomatic arch. Which of the following imaging views is most appropriate for assessing a suspected zygomatic bone fracture?", "options": [{"label": "A", "text": "Caldwell's view", "correct": false}, {"label": "B", "text": "Water's view", "correct": true}, {"label": "C", "text": "Lateral skull view", "correct": false}, {"label": "D", "text": "Towne's view", "correct": false}], "correct_answer": "B. Water's view", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iwCU65G8oUXu1ZnpMA161740041608.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/E5NDGAgLaXo1BSCU1DX61748344845.mp3", "video": ""}, {"text": "All of the following are true regarding the clinical presentation of zygomatic bone fracture except?", "options": [{"label": "A", "text": "Epistaxis", "correct": false}, {"label": "B", "text": "Anesthesia in infra-orbital nerve distribution", "correct": false}, {"label": "C", "text": "Flattening of malar prominence", "correct": false}, {"label": "D", "text": "Deranged dental occlusion", "correct": true}], "correct_answer": "D. Deranged dental occlusion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Q2D3hpGR6R8WyOE0SF8R1748344709.mp3", "video": ""}, {"text": "A 22-year-old male presents with pain in the jaw and difficulty opening his mouth after a fall from a bicycle, landing directly on his chin. On examination, there is tenderness at the left preauricular region with limited mouth opening. CT scan confirms an undisplaced fracture of the left mandibular condyle. The patient has no other injuries and is otherwise stable. What is the most appropriate management?", "options": [{"label": "A", "text": "Open reduction with internal fixation (ORIF)", "correct": false}, {"label": "B", "text": "Observation with a soft diet", "correct": false}, {"label": "C", "text": "Intermaxillary fixation (IMF)", "correct": true}, {"label": "D", "text": "Surgical excision of the condylar head", "correct": false}], "correct_answer": "C. Intermaxillary fixation (IMF)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h0tOe7OeyDwEMl4PaT7T1740041531.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1ymMUUBQcbCFf9F7aPB81748344507.mp3", "video": ""}, {"text": "A 24-year-old male presents to the emergency department after a motorcycle accident. He complains of severe pain in his lower jaw, difficulty closing his mouth properly, and numbness in his lower lip on the right side. Physical examination reveals swelling and tenderness over the right jaw, malocclusion, and a palpable step-off in the premolar region. The paresthesia in the patient’s lower lip is most likely due to the involvement of which nerve?", "options": [{"label": "A", "text": "Facial nerve", "correct": false}, {"label": "B", "text": "Inferior alveolar nerve", "correct": true}, {"label": "C", "text": "Mental nerve", "correct": false}, {"label": "D", "text": "Lingual nerve", "correct": false}], "correct_answer": "B. Inferior alveolar nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GAkSNMgZutev9eOAtckk1739297810.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7LTwJ4K5pCihD7sLjNDO1748344271.mp3", "video": ""}, {"text": "A 3-month-old female infant presents with feeding difficulties and a noticeable facial deformity. On examination, the infant has a unilateral complete cleft involving the left lip, extending through the alveolus and hard palate, with an intact soft palate on the left side. The right side of the lip and palate are completely intact. What is the LAHSAL classification for this patient's cleft abnormality?", "options": [{"label": "A", "text": "00HSAL", "correct": false}, {"label": "B", "text": "LAH000", "correct": true}, {"label": "C", "text": "LAHS00", "correct": false}, {"label": "D", "text": "LAHSAL", "correct": false}], "correct_answer": "B. LAH000", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/deqzHSL4e6odY6k5x0wk1740041178.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Letter</th>\n<th>Meaning</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>L</td>\n<td>Lip</td>\n</tr>\n<tr>\n<td>A</td>\n<td>Alveolus</td>\n</tr>\n<tr>\n<td>H</td>\n<td>Hard palate</td>\n</tr>\n<tr>\n<td>S</td>\n<td>Soft palate</td>\n</tr>\n<tr>\n<td>Capital letter</td>\n<td>Complete cleft</td>\n</tr>\n<tr>\n<td>Lowercase letter</td>\n<td>Incomplete cleft</td>\n</tr>\n<tr>\n<td>\"0\"</td>\n<td>Normal segment</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MTxOr4Yuuh46Rgvk7SQP1746107166.mp3", "video": ""}, {"text": "A mother brings her apparently normal 20-day-old newborn to the pediatric clinic with a complaint of milk coming through the nasal passages of the baby during feeding. Upon examination, you find the following: This condition is due to the failure of which of the following processes during embryonic development?", "options": [{"label": "A", "text": "Fusion of the maxillary and medial nasal processes", "correct": false}, {"label": "B", "text": "Formation of the lateral palatine processes", "correct": false}, {"label": "C", "text": "Fusion of the palatal shelves", "correct": true}, {"label": "D", "text": "Formation of the primary palate", "correct": false}], "correct_answer": "C. Fusion of the palatal shelves", "question_images": ["https://image.prepladder.com/content/qCSuYCMHV1YG20RGobxL1740040837.png"], "explanation_images": ["https://image.prepladder.com/content/He5xxk2vSEUUN7r8rOwV1740040892.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JoXV0oKHaDy817AKIGq01748342224.mp3", "video": ""}, {"text": "A 45-year-old male is diagnosed with a mandibular condyle fracture following an assault. The fracture is associated with malocclusion and facial asymmetry. Which of the following is a common post-surgical complication after open reduction and internal fixation (ORIF) of this fracture?", "options": [{"label": "A", "text": "Temporomandibular joint ankylosis", "correct": false}, {"label": "B", "text": "Persistent pain and facial contour deformities", "correct": true}, {"label": "C", "text": "Complete loss of mandibular function", "correct": false}, {"label": "D", "text": "Intraoral hemorrhage", "correct": false}], "correct_answer": "B. Persistent pain and facial contour deformities", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mandibular condyle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma (e.g., assaults, accidents)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often involves multiple mandibular fractures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open reduction and internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (ORIF)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Incisions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Retromandibular, Preauricular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent pain, malocclusion, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> deformities; increased risk with multiple fractures</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/a7QTKSnJrHYuIxtRXmny1748345530.mp3", "video": ""}, {"text": "All of the following statements are true regarding the management of midface fractures, except?", "options": [{"label": "A", "text": "Interdental or intermaxillary fixation is not mandatory", "correct": true}, {"label": "B", "text": "Reestablish the proper dentoskeletal relationship", "correct": false}, {"label": "C", "text": "Immobilize the fractured bone", "correct": false}, {"label": "D", "text": "Ensure normal postoperative occlusion", "correct": false}], "correct_answer": "A. Interdental or intermaxillary fixation is not mandatory", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VjdBAJicsn4oyZB8e1u61748345381.mp3", "video": ""}, {"text": "A 3-month-old infant presents to the pediatric clinic with feeding difficulties and nasal regurgitation. On examination, the infant has a cleft involving only the soft palate. There are no other abnormalities or syndromic features observed. When should surgery be planned for this infant with a cleft of only the soft palate?", "options": [{"label": "A", "text": "At birth", "correct": false}, {"label": "B", "text": "At 6 months", "correct": true}, {"label": "C", "text": "After 1 year", "correct": false}, {"label": "D", "text": "After 5 years", "correct": false}], "correct_answer": "B. At 6 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cleft lip repair </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cleft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> repair </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Millard <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> <span class=\"customMeta\" data-dictid=\"b03362a9691692777180a2605bdfbf\">advancement</span> technique(<strong>most widely used</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bardach's Method</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Le Mesurier's</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Von Langenbeck Method (bipedicled)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thompson</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wardill-Kilner Method/ V-Y <span class=\"customMeta\" data-dictid=\"6c2e1291af169277719471dd1831c1\">plasty</span> (unipedicled)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tennison-Randall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cleft lip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-6 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-5 months</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cleft palate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hard <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-18 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both soft and hard palate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 staged</p>\n<ul>\n<li>Soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> - 6 months</li>\n<li>Hard <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> - 15-18 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cleft lip and palate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 staged</p>\n<ul>\n<li>Cleft lip and soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> - 5-6 months</li>\n<li>Hard <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> - 15-18 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 staged</p>\n<ul>\n<li>Cleft lip and soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> - 4-5 months</li>\n<li>Hard <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> - 15-18 months</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4FGOHmzn8UYzN4KTpeka1748344089.mp3", "video": ""}, {"text": "A 2-day-old male infant is born with a unilateral cleft lip and palate. He is the first child of healthy, non-consanguineous parents with no significant family history. On physical examination, the infant has a noticeable cleft lip and palate. No other obvious abnormalities are noted. You suspect a syndromic association. Which of the following is the most common syndrome associated with cleft lip?", "options": [{"label": "A", "text": "Van der Woude syndrome", "correct": true}, {"label": "B", "text": "Pierre Robin sequence", "correct": false}, {"label": "C", "text": "Treacher Collins syndrome", "correct": false}, {"label": "D", "text": "DiGeorge syndrome", "correct": false}], "correct_answer": "A. Van der Woude syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GG53qJTe2o8exbPcVHI91748343867.mp3", "video": ""}, {"text": "A 3-day-old male neonate is brought to you by his parents, concerned about the appearance of his face. On examination, the neonate has the appearance as shown in the image. Which of the following embryological events is most likely responsible for this defect?", "options": [{"label": "A", "text": "Failure of fusion between the lateral palatine processes and nasal septum.", "correct": false}, {"label": "B", "text": "Non-fusion of the maxillary prominences and medial nasal prominences.", "correct": true}, {"label": "C", "text": "Incomplete fusion of the mandibular prominences.", "correct": false}, {"label": "D", "text": "Non-fusion of the lateral nasal prominences and the medial nasal prominences.", "correct": false}], "correct_answer": "B. Non-fusion of the maxillary prominences and medial nasal prominences.", "question_images": ["https://image.prepladder.com/content/LRcbNMfAdRWoq2AWyMAz1740040959.png"], "explanation_images": ["https://image.prepladder.com/content/hzJShgB5A77TSQ6aiam51740041075.png", "https://image.prepladder.com/content/MRY5Y1evLfqMhaV8k3NU1740041100.png", "https://image.prepladder.com/content/YhFHSVdgCTS9yYI9LplK1740041125.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8PgXO4Y9ExmEs012jFJr1748342505.mp3", "video": ""}, {"text": "A 60-year-old patient is found to have a carotid body tumor that completely encases the carotid vessels, posing significant surgical challenges. According to the Shamblin classification system, what type of tumor does this describe?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": true}, {"label": "D", "text": "Cannot be determined.", "correct": false}], "correct_answer": "C. Type III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rPeZ0fjPDML289trPoJ61740039456.png", "https://image.prepladder.com/content/hg20mFfi3YaXFgeczqMK1740039504.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carotid body tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chemoreceptor cells</strong> at the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> body (carotid bifurcation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> (e.g., high-altitude exposure)</li>\n<li>Family history in ~10%</li>\n<li>Genetic mutations in SDH enzyme</li>\n<li>Pheochromocytoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow-growing, painless mass at <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> bifurcation</li>\n<li>Often pharyngeal mass</li>\n<li>Firm, rubbery, pulsatile, side-to-side mobility</li>\n<li>Bruit possible</li>\n<li>Avoid oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for <span class=\"customMeta\" data-dictid=\"d420f34d5816927771943f346531fc\">para</span> pharyngeal swellings</li>\n<li>Usually benign; <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> are rare</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tools</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Carotid Angiogram</strong>: Visualizes splayed <span class=\"customMeta\" data-dictid=\"6c076ff67d1692777183dff2a71da1\">bifurcation</span> and outlines blood vessels</li>\n</ul>\n<img alt=\"\" data-author=\"Yasin Kilic • Izatullah Jalalzai • Ebubekir Sönmez • Bilgehan Erkut • Mansoor Jalalzai\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.cureus.com/articles/213018-the-surgical-treatment-of-carotid-body-tumor-as-well-as-the-prevention-and-management-of-complications#!/\" data-tags=\"\" height=\"3046\" src=\"https://image.prepladder.com/content/hg20mFfi3YaXFgeczqMK1740039504.png\" width=\"4167\"/>\n<ul>\n<li>MRI: Provides detailed <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> information</li>\n<li>Contraindications: <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> and fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> (risk of bleeding)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shamblin Classification</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type I: Localized, &lt;180° of <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> vessels <strong>(Option A ruled out)</strong></li>\n<li>Type II: Encases &gt;180° of <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> vessels <strong>(Option B ruled out)</strong></li>\n<li>Type III: Completely encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> vessels, challenging to <span class=\"customMeta\" data-dictid=\"bb68040e971692777197f746c3b6c6\">resect</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical: Careful in elderly; may require vessel reconstruction</li>\n<li>Alternative: <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">Radiotherapy</span> (not curative)</li>\n<li>Surgical Resection: For large tumors, may need <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"ceb06d7c9c169277718265ef7f9bf8\">autograft</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> to restore blood flow</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qFvaFDnLM6HqG5I0TUIo1748263894.mp3", "video": ""}, {"text": "The intermaxillary segment gives rise to all of the following structures EXCEPT:", "options": [{"label": "A", "text": "Philtrum of the lip", "correct": false}, {"label": "B", "text": "Primary palate", "correct": false}, {"label": "C", "text": "Secondary palate", "correct": true}, {"label": "D", "text": "Four incisor teeth", "correct": false}], "correct_answer": "C. Secondary palate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Jjg3z9sRnmjOGgre106P1740040671.png", "https://image.prepladder.com/content/12jWF5QyrMYxFoo3NzL71740040704.png", "https://image.prepladder.com/content/X6IDuOYr60PmfBzI6QG61740040789.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JLpsepoQzrzgZ3NfpbsC1748342025.mp3", "video": ""}, {"text": "Match the structures formed in Column II with the corresponding prominence in Column I: Column I Column II A. Lateral Nasal Prominence 1. Lower lip B. Maxillary Prominence 2. Philtrum of upper lip, crest, and tip of nose C. Medial Nasal Prominence 3. Cheeks, lateral portion of upper lip D. Mandibular Prominence 4. Alae of nose", "options": [{"label": "A", "text": "A-2, B-1, C-3, D-2", "correct": false}, {"label": "B", "text": "A-4, B-1, C-3, D-2", "correct": false}, {"label": "C", "text": "A-2, B-3, C-4, D-1", "correct": false}, {"label": "D", "text": "A-4, B-3, C-2, D-1", "correct": true}], "correct_answer": "D. A-4, B-3, C-2, D-1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3S2gCXtbDuw8u6ibvXXT1740040445.png", "https://image.prepladder.com/content/pBIZiO2fptyt3qQ29qU11740040555.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prominence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Formed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontonasal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forehead, bridge of nose, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> prominences.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cheekst, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> portion of upper lip.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial nasal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Philtrum of upper lip, <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">crest</span> and tip of nose.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral nasal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alae of nose.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mandibular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower lip.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0C0KVvGTic0s8ynefaeD1748341655.mp3", "video": ""}, {"text": "A 55-year-old male patient with squamous cell carcinoma of the oral cavity undergoes a right radical neck dissection. Three days postoperatively, the patient complains of shoulder weakness and difficulty in lifting his right arm above his shoulder. On physical examination, he has a limited range of motion in the right shoulder and exhibits winging of the scapula on the right side. What is the most likely nerve injured during the neck dissection that could explain this patient’s symptoms?", "options": [{"label": "A", "text": "Accessory nerve (CN XI)", "correct": true}, {"label": "B", "text": "Phrenic nerve", "correct": false}, {"label": "C", "text": "Cervical sympathetic chain", "correct": false}, {"label": "D", "text": "Hypoglossal nerve (CN XII)", "correct": false}], "correct_answer": "A. Accessory nerve (CN XI)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HqMOLjfOiQn50UN4nqNE1748341434.mp3", "video": ""}, {"text": "A 60-year-old male patient presents to the clinic with a non-healing ulcer on the left lateral border of the tongue. Upon examination, the lesion measures 2 cm and has been present for 6 weeks and there is a palpable lymph node in the left submandibular region. After evaluation, the surgeon decides to perform a neck dissection. The image below depicts the lymph nodes to be removed during the procedure. What type of neck dissection is planned for this patient?", "options": [{"label": "A", "text": "Radical neck dissection", "correct": false}, {"label": "B", "text": "Modified radical neck dissection", "correct": false}, {"label": "C", "text": "Supraomohyoid neck dissection", "correct": true}, {"label": "D", "text": "Extended supraomohyoid neck dissection", "correct": false}], "correct_answer": "C. Supraomohyoid neck dissection", "question_images": ["https://image.prepladder.com/content/eCBUHgQn9K2KC7mwbms51740040339.png"], "explanation_images": ["https://image.prepladder.com/content/w2EkVgkNJWsfXkwnm04P1740040370.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>LN removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Other structures removed/Preserved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical Neck Dissection</strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN XI, IJV, and SCM removed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (MRND) I</strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN XI preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRND II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN XI, IJV preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRND III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN XI, IJV, SCM preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extended Neck Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN XI, IJV, SCM removed + one/more LN groups +/- Non <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> structures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Selective Neck Dissections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>LN removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary site of cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supra-omohyoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extended Supra-omohyoid</strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I - IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and oropharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postero-Lateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin over the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> and upper neck</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II - IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oropharynx, Hypopharynx, Larynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior/ Central</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>VI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thyroid/ Midline structures</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ubxwuvvgfefnGowDeTd41748340848.mp3", "video": ""}, {"text": "Which lymph node level in the neck is primarily responsible for draining the thyroid gland?", "options": [{"label": "A", "text": "Level Ib", "correct": false}, {"label": "B", "text": "Level IIa", "correct": false}, {"label": "C", "text": "Level VI", "correct": true}, {"label": "D", "text": "Level III", "correct": false}], "correct_answer": "C. Level VI", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Structures Drained</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level I</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Submental and Submandibular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Level Ia</strong>-</p>\n<p>Under the chin, between the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> bellies of the digastric</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Lower lip, floor of the mouth, tip of the tongue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Level Ib</strong> <strong>(Option A ruled out)</strong>-</p>\n<p>Between the <span class=\"customMeta\" data-dictid=\"55c062d44f16927771919375042b03\">mandible</span> and the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Upper lip, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> lower lip, oral cavity, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> tongue, <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> gland</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level II</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Upper <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">Jugular</span> (Deep Cervical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Level IIa</strong> <strong>(Option B ruled out)</strong>-</p>\n<p>Upper internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Oropharynx, nasopharynx, <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland, auricle, adjacent scalp</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Level IIb</strong>-</p>\n<p>Posterior to <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Similar to Level IIa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level III</strong> <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Middle <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">Jugular</span> (Deep Cervical)</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Middle third of internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein, between <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone and <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">Jugular</span> (Deep Cervical)</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Lower third of internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein, from <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> to clavicle</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level V</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Level Va</strong>-</p>\n<p>Posterior to SCM, above the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Nasopharynx, scalp, <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Level Vb</strong>-</p>\n<p>Posterior to SCM, below the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Thyroid gland, hypopharynx, esophagus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level VI</strong> <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Anterior (Central) Compartment</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> arteries, from <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone to <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> notch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Level VII</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Superior Mediastinal</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Below the <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> notch, in the superior mediastinum</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/skauxlJhW0Sl4hO51hZ51748340605.mp3", "video": ""}, {"text": "Which of the following nerves is most likely to be injured during surgery in the posterior triangle of the neck, potentially leading to weakness in shoulder elevation?", "options": [{"label": "A", "text": "Hypoglossal Nerve (CN XII)", "correct": false}, {"label": "B", "text": "Vagus Nerve (CN X)", "correct": false}, {"label": "C", "text": "Phrenic Nerve", "correct": false}, {"label": "D", "text": "Spinal Accessory Nerve (CN XI)", "correct": true}], "correct_answer": "D. Spinal Accessory Nerve (CN XI)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0kjG9emwnY8xOo6r3RqA1740040271.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Anterior Triangle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Triangle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Boundaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Contents</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Submental Triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>Hyoid bone</li>\n<li>Anterior bellies of the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscles</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Submental <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Submandibular Triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>Mandible</li>\n<li>Anterior and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> bellies of the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Submandibular gland, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Carotid Triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>SCM</li>\n<li>Superior belly of the <span class=\"customMeta\" data-dictid=\"ceb9263ebb16927771947ec93fc73f\">omohyoid</span> muscle</li>\n<li>Posterior belly of the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (bifurcation into internal and external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> arteries)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Muscular Triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>SCM</li>\n<li>Superior belly of the omohyoid</li>\n<li>Midline of the neck</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Infrahyoid muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\"> </td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Triangle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Boundaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Contents</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p><strong>Posterior Triangle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Occipital Triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>SCM</li>\n<li>Trapezius</li>\n<li>Inferior belly of omohyoid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve (CN XI) <strong>(Option D)</strong>, <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> trunks, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> plexus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Supraclavicular (Subclavian) Triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>Clavicle</li>\n<li>SCM</li>\n<li>Inferior belly of omohyoid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:middle\">\n<p>Subclavian <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and vein, external <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein, <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eGApaom0zRYEzEhKnmM91748267002.mp3", "video": ""}, {"text": "Which of the following conditions is most commonly associated with a cervical rib?", "options": [{"label": "A", "text": "Rotator Cuff Tear", "correct": false}, {"label": "B", "text": "Cervical Spondylosis", "correct": false}, {"label": "C", "text": "Thoracic Outlet Syndrome", "correct": true}, {"label": "D", "text": "Pancoast’s syndrome", "correct": false}], "correct_answer": "C. Thoracic Outlet Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/t9V8lYPYIZNUkNZnw84M1740040154.png", "https://image.prepladder.com/content/RM0Mq6lujxyYjDVrF8gQ1740040195.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NZ796l1U4p7y1K1tTVXO1748264901.mp3", "video": ""}, {"text": "Which branchial cleft remnant typically passes behind the carotid artery?", "options": [{"label": "A", "text": "First branchial cleft remnant", "correct": false}, {"label": "B", "text": "Second branchial cleft remnant", "correct": false}, {"label": "C", "text": "Third branchial cleft remnant", "correct": true}, {"label": "D", "text": "Fourth branchial cleft remnant", "correct": false}], "correct_answer": "C. Third branchial cleft remnant", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0GHdSuywp1J5TUgs2nah1740040086.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cunQvrMm8RZcLRTpEI5r1748264422.mp3", "video": ""}, {"text": "A branchial fistula typically presents with which of the following characteristics?", "options": [{"label": "A", "text": "A midline neck mass that moves with swallowing", "correct": false}, {"label": "B", "text": "A lateral neck opening that drains mucus or saliva", "correct": true}, {"label": "C", "text": "A neck swelling that enlarges after a respiratory infection", "correct": false}, {"label": "D", "text": "A solid mass in the posterior triangle of the neck", "correct": false}], "correct_answer": "B. A lateral neck opening that drains mucus or saliva", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MAfcIdI6dYTM3b2DxEWj1740040014.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yPzVtTFRsrzvXw9TAa8Z1748264291.mp3", "video": ""}, {"text": "A 38-year-old patient presents with a soft, translucent swelling on the front edge of the sternocleidomastoid muscle. The swelling is non-tender and has not been associated with any infection. It is diagnosed as a branchial cyst. Which of the following is false regarding the given diagnosis?", "options": [{"label": "A", "text": "Typical location is the meeting of upper and middle thirds of sternocleidomastoid.", "correct": false}, {"label": "B", "text": "It has an onset in late adulthood.", "correct": true}, {"label": "C", "text": "Cancerous lymph nodes may have to be ruled out.", "correct": false}, {"label": "D", "text": "Complete removal is done, ideally when not infected.", "correct": false}], "correct_answer": "B. It has an onset in late adulthood.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zLbdFBt4Zs4UdpJ2xf8a1740039812.png", "https://image.prepladder.com/content/Pd6K2i27jxToMXrHXo7I1740039936.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2f8aHUZTv1leVTx8rcwF1747152407.mp3", "video": ""}, {"text": "An infant presents with a translucent swelling in the neck that has been expanding over time as shown in the image below The swelling is filled with clear lymph and increases in size when the infant coughs.. Which of the following is false regarding the given condition?", "options": [{"label": "A", "text": "Common locations include the cheek, axilla, groin, and mediastinum.", "correct": false}, {"label": "B", "text": "It has an unpredictable growth pattern.", "correct": false}, {"label": "C", "text": "It is incompressible and cystic in nature.", "correct": true}, {"label": "D", "text": "Injection of sclerosing agents can be given to reduce size.", "correct": false}], "correct_answer": "C. It is incompressible and cystic in nature.", "question_images": ["https://image.prepladder.com/content/gJoGdGahLgvc52MDSgEF1740039582.png"], "explanation_images": ["https://image.prepladder.com/content/Lkw9lhDYkI7xAy8LXsdb1740039621.png", "https://image.prepladder.com/content/ZL6ZzSnCAs2Fe4T0Twgn1740039676.png", "https://image.prepladder.com/content/Gs1qRKxVxuLliWHzSR5X1740039719.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s5EdHJHdy9N2agbKSMJj1748264119.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old male presents with a 2 cm ulcerative lesion located on the lateral border of the anterior portion of the tongue, closer to the tip . During surgical planning, which group of lymph nodes is the most likely initial site of lymphatic drainage for this lesion?", "options": [{"label": "A", "text": "Level I", "correct": false}, {"label": "B", "text": "Level II", "correct": true}, {"label": "C", "text": "Level III", "correct": false}, {"label": "D", "text": "Level IV", "correct": false}], "correct_answer": "B. Level II", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CvFic876QbFWxozLOqsY1739246386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smoking</li>\n<li>Spirit</li>\n<li>Sepsis</li>\n<li>Superficial glossitis</li>\n<li>Syphilis</li>\n<li>Spices</li>\n<li>Sharp tooth</li>\n<li>Leukoplakia, erythroplakia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless ulcer/swelling</li>\n<li>Excessive salivation</li>\n<li>Dysphagia</li>\n<li>Restricted tongue movement</li>\n<li>Halitosis</li>\n<li>Voice Change: In tumors of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> tongue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wedge biopsy; FNAC of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Laryngoscopy: To view <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> growth</li>\n<li>CT/MRI: Assess tumor extent</li>\n<li>Orthopantomogram</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgery:</strong>\n<ul>\n<li>For tumors &lt;1 cm or <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ: Wide local excision, 1 cm margin clearance.</li>\n<li>For tumors 1-2 cm: Partial <span class=\"customMeta\" data-dictid=\"059d3d36a01692777188310308d835\">glossectomy</span> with 2 cm margin.</li>\n<li>For tumors &gt;2 cm: <span class=\"customMeta\" data-dictid=\"e67798bd521692777188148578a22a\">Hemiglossectomy</span> removing <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 2/3 of tongue on one side.</li>\n<li>Posterior third growth: Total <span class=\"customMeta\" data-dictid=\"059d3d36a01692777188310308d835\">glossectomy</span> (Kocher's approach).</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Palpable mobile <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes: Radical neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> (unilateral/bilateral).</li>\n<li>Mandible involvement: Hemimandibulectomy.</li>\n<li>Commando Operation: Combined procedures involving wide <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or hemiglossectomy, hemimandibulectomy, and radical neck dissection.</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Radiotherapy:</strong>\n<ul>\n<li>Small primary tumor: Curative <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> (Brachytherapy).</li>\n<li>Large primary tumor: Pre-operative <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> to reduce tumor size.</li>\n<li>Advanced tumors/secondaries: <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">Palliative</span> external radiotherapy.</li>\n<li>Post-operative: <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">Radiotherapy</span> to reduce <span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\">relapse</span> risk.</li>\n<li>Posterior third tumor: Curative and <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> radiotherapy.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Chemotherapy:</strong></li>\n</ul>\n<ul>\n<li>Used post-operatively or for palliation.</li>\n<li>Price-Hill Regimen: Methotrexate, vincristine, adriamycin, <span class=\"customMeta\" data-dictid=\"4ad57d5a2f169277718396fb674d4e\">bleomycin</span> and mercaptopurine.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2ow9yrzp1DlPgR7JXd5j1748247497.mp3", "video": ""}, {"text": "A 65-year-old patient presents with metastatic adenocarcinoma, but the primary tumor site remains unidentified. Which of the following is the most appropriate next step in the workup to help locate the primary tumor?", "options": [{"label": "A", "text": "Complete blood count", "correct": false}, {"label": "B", "text": "PET scan", "correct": true}, {"label": "C", "text": "Start chemotherapy", "correct": false}, {"label": "D", "text": "Exploratory surgery", "correct": false}], "correct_answer": "B. PET scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OwRuszZSm5JqrQicaOns1739249185.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b9wJBDTrfhdW2Z3F1oPF1748263381.mp3", "video": ""}, {"text": "A 58-year-old patient who recently had a neck dissection is experiencing swelling, pain, and fluid accumulation in the surgical area. Which of the following is NOT a typical complication associated with neck dissection?", "options": [{"label": "A", "text": "Wound dehiscence", "correct": false}, {"label": "B", "text": "Chyle leak", "correct": false}, {"label": "C", "text": "Accessory nerve injury", "correct": false}, {"label": "D", "text": "Facial nerve paralysis", "correct": true}], "correct_answer": "D. Facial nerve paralysis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraoperative Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postoperative Complication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemorrhage</li>\n<li>Injury to nerves\n\t\t\t\t<ul>\n<li>Accessory nerve injury <strong>(Option C)</strong></li>\n<li>Marginal mandibular nerve injury</li>\n<li>Vagus nerve injury</li>\n<li>Hypoglossal nerve injury</li>\n<li>Phrenic nerve injury</li>\n<li>Sympathetic trunk injury</li>\n</ul>\n</li>\n<li>Thoracic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury <strong>(Option B)</strong></li>\n<li>Pneumothorax</li>\n<li>Salivary leakage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemorrhage</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> <strong>(Option A)</strong></li>\n<li>Wound infection</li>\n<li>Cephalic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> stasis</li>\n<li>Bronchopneumonia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NRVZJrzBCJsdQikjUHu21748263297.mp3", "video": ""}, {"text": "A patient undergoes a neck dissection that involves removing lymph nodes from levels I-V, while preserving the spinal accessory nerve, and internal jugular vein. What type of neck dissection was performed?", "options": [{"label": "A", "text": "Radical neck dissection", "correct": false}, {"label": "B", "text": "Anterolateral Neck Dissection", "correct": false}, {"label": "C", "text": "Modified Radical Neck Dissection Type II", "correct": true}, {"label": "D", "text": "Modified Radical Neck Dissection Type III", "correct": false}], "correct_answer": "C. Modified Radical Neck Dissection Type II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:538px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type of Neck Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nodes Removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Structures Preserved</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Comprehensive: </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Radical Neck Dissection (RND) <strong>(Option A)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Bilateral Radical Neck Dissection</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - V (both sides)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Modified Radical Neck Dissection Type I</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>SAN</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Modified Radical Neck Dissection Type II <strong>(Option C)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>SAN, SCM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Modified Radical Neck Dissection Type III<strong> (Option D)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>SAN, SCM, IJV</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Selective <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Supraomohyoid Neck Dissection</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - III</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>SAN, SCM, IJV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Extended Supraomohyoid (Anterolateral Neck Dissection) <strong>(Option B)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level I - IV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Posterolateral Neck Dissection</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level II - V with suboccipital, <span class=\"customMeta\" data-dictid=\"25d15957af1692777197fb801dd929\">retroauricular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ol>\n<li>Anterior/ Central Dissection</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Level VI</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/d20A4HtEECDjZN4Z3IKw1748263111.mp3", "video": ""}, {"text": "A 58-year-old male is scheduled for a neck dissection due to metastatic squamous cell carcinoma of the oral cavity. Which incision will the surgeon choose to provide optimal access to all cervical lymph node levels?", "options": [{"label": "A", "text": "Macfee incision", "correct": false}, {"label": "B", "text": "Modified Schobinger incision", "correct": true}, {"label": "C", "text": "Y-shaped incision", "correct": false}, {"label": "D", "text": "Modified Macfee incision", "correct": false}], "correct_answer": "B. Modified Schobinger incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qiVMkUmRignIDCaJFocS1739248554.png", "https://image.prepladder.com/content/a3aqNpzYxL90yrdj7Rv41739248736.png", "https://image.prepladder.com/content/FLwQoNSh7D9rs2gtSCMh1739248801.png", "https://image.prepladder.com/content/s2adGknCusTxLKUpHbSY1739248851.png", "https://image.prepladder.com/content/l0gIeJ2FBjf3gc4EceTV1739248923.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bKILr4pu7ILjShiTR8Ma1745396944.mp3", "video": ""}, {"text": "A 60-year-old female diagnosed with oral cavity cancer presents with a non-healing ulcer on her lower lip. Which of the following lymph node levels is most likely involved in this patient?", "options": [{"label": "A", "text": "Levels IV and V", "correct": false}, {"label": "B", "text": "Levels II, III and IV", "correct": false}, {"label": "C", "text": "Levels I, II and III", "correct": true}, {"label": "D", "text": "Level VII", "correct": false}], "correct_answer": "C. Levels I, II and III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Q5DlB6PpBhE13fdgY2W71739248350.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:686px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levels </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymph nodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boundaries </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated primary malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ia: <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">Submental</span> </strong></p>\n<br/>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle, <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone, midline, mandible.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Floor of mouth,</li>\n<li>Anterior tongue,</li>\n<li>Mandibular alveolar ridge,</li>\n<li>Lower lip <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ib: <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">Submandibular</span> nodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> bellies of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> border of mandible.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> <strong>(Option C)</strong></li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</li>\n<li>Mid-face soft tissues</li>\n<li>Submandibular gland</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Upper <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> group</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skull base, <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> plane extending from <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone and sternocleidomastoid.</p>\n\t\t\t \n\n\t\t\t<p>IIa: <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> to the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve.</p>\n<p>IIb: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> to the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nasal and oral cavities,<strong>(Option C)</strong></li>\n<li>Nasopharynx</li>\n<li>Oropharynx</li>\n<li>Hypopharynx</li>\n<li>Larynx, <strong>(Option B)</strong></li>\n<li>Major salivary glands.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strap muscles, sternocleidomastoid, <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> plane from <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> border of <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral cavity</li>\n<li>Nasopharynx</li>\n<li>Oropharynx</li>\n<li>Hypopharynx</li>\n<li>Larynx <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strap muscles, sternocleidomastoid, and clavicle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypopharynx</li>\n<li>Oropharynx</li>\n<li>Larynx <strong>(Option B)</strong></li>\n<li>Thyroid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <strong>(Option A)</strong></li>\n<li>Cervical esophagus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>V</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Va: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> to <span class=\"customMeta\" data-dictid=\"19a4409d731692777198b6fead1463\">SCM</span> muscle, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to splenius capitis and trapezius, superior to the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nasopharynx</li>\n<li>Oropharynx</li>\n<li>Thyroid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vb: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> to <span class=\"customMeta\" data-dictid=\"19a4409d731692777198b6fead1463\">SCM</span> muscle, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to trapezius, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve, superior to the clavicle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyoid bone, <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> notch, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> extent of the <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles bilaterally.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lower lip</li>\n<li>Soft tissues of the chin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VII</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> nodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior to the <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> in the upper mediastinum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nasopharynx</li>\n<li>Pharyngeal wall</li>\n<li>Oropharynx <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WQqCZUfrJDySCxFma1NS1748262768.mp3", "video": ""}, {"text": "A 35-year-old male presents with a smooth, tender swelling in the right lower jaw in relation to tooth caries. A panoramic radiograph shows a well-defined radiolucency around the roots of the lower right first molar. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dentigerous cyst", "correct": false}, {"label": "B", "text": "Dental cyst", "correct": true}, {"label": "C", "text": "Ameloblastoma", "correct": false}, {"label": "D", "text": "Epulis", "correct": false}], "correct_answer": "B. Dental cyst", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JJPOdi0KkfOJ8XuMjRUL1739247985.png", "https://image.prepladder.com/content/FdqfHprsyiH25qUKf1he1739248081.png", "https://image.prepladder.com/content/8K1U1hJBWP94N8yLxfV71739248203.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:762px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ameloblastoma </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dentigerous Cyst</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dental Cyst</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arises from <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> epithelium, probably from the enamel/ <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> lamina.</li>\n<li>Occurs commonly in the <span class=\"customMeta\" data-dictid=\"55c062d44f16927771919375042b03\">mandible</span> or maxilla, occasionally in the skull base</li>\n<li>Locally <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumor</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilocular <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> arising to the <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> from an unerupted tooth.</li>\n<li>Common in the <span class=\"customMeta\" data-dictid=\"47961831121692777191474a97c7d3\">lower jaw</span> but can also occur in the upper jaw.</li>\n<li>Occurs over the <span class=\"customMeta\" data-dictid=\"7c11c2cc6a1692777185bfb953fa72\">crown</span> of an unerupted tooth; commonly seen in relation to premolars or molars.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs under the root of a chronically infected dead erupted tooth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless,</li>\n<li>Progressively enlarging <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the jaw (usually mandible),</li>\n<li>Smooth and hard, with an intact inner table.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless,</li>\n<li>Smooth, <strong>hard</strong> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> over the <span class=\"customMeta\" data-dictid=\"7c11c2cc6a1692777185bfb953fa72\">crown</span> of an unerupted tooth,</li>\n<li>Causes expansion of the outer table of the mandible.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smooth, tender <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the jaw related to a <span class=\"customMeta\" data-dictid=\"382abada90169277718335a73c469a\">caries</span> tooth,</li>\n<li>Causes expansion of the jaw bone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orthopantomogram (OPG): <span class=\"customMeta\" data-dictid=\"7fa8553470169277718949dfac4020\">Honeycomb</span> appearance</li>\n</ul>\n<img alt=\"\" data-author=\"Padmashri P Kalmegh, Alka H Hande, Madhuri N Gawande, Swati Krishnakant Patil\" data-hash=\"\" data-license=\"CC-BY-3.0\" data-source=\"https://www.researchgate.net/figure/Multilocular-radiolucency-with-honeycomb-appearance_fig1_365119504\" data-tags=\"\" height=\"324\" src=\"https://image.prepladder.com/content/JJPOdi0KkfOJ8XuMjRUL1739247985.png\" width=\"300\"/>\n<ul>\n<li>CT scan</li>\n<li>Biopsy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orthopantomogram (OPG): Tooth within the cyst, which is well defined.</p>\n<p><img alt=\"\" custommeta\"=\"\" data-author=\"Coronation &lt;span class=\" data-dictid=\"02cf7655661692777185e2bf5c3254\"/>Dental Specialty Group, Jbarta\" data-hash=\"\" data-license=\"CC-BY-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:JawCyst_(with_arrows).jpg\" data-tags=\"\" height=\"81\" src=\"https://image.prepladder.com/content/TNVKNTKgdKSF0DBoUa051739248026.png\" width=\"200\" /&gt;</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orthopantomogram (OPG): <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">Circular</span> <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> area in relation to the root of a normally erupted tooth.</p>\n<br/>\n<img alt=\"\" data-author=\"Mohamed A Mrad, Qutaiba Shah Mardan, Nehal A Mahabbat\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/This-is-a-dental-panoramic-X-ray-that-shows-the-bilateral-radicular-cysts-circled-in-red_fig2_346537478\" data-tags=\"\" height=\"92\" src=\"https://image.prepladder.com/content/FdqfHprsyiH25qUKf1he1739248081.png\" width=\"200\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Segmental <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of <span class=\"customMeta\" data-dictid=\"55c062d44f16927771919375042b03\">mandible</span> or <strong>hemimandibulectomy</strong> with <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> of the mandible.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small cyst: <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> of the cyst.</li>\n<li>Large cysts: Initial <span class=\"customMeta\" data-dictid=\"f577d7382a16927771915daa0fd8ea\">marsupialization</span> followed by excision.</li>\n<li>Extraction of unerupted tooth.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics,</li>\n<li>Drainage or <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> with <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">extraction</span> of the infected tooth.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lsWwiHnkVkXkR8EI1sxZ1748262529.mp3", "video": ""}, {"text": "A 55-year-old male presents with a large tumor involving the floor of the maxillary sinus, causing facial swelling and nasal obstruction. During surgery, the surgical team uses the approach shown in the image. Identify the type of incision used in this procedure.", "options": [{"label": "A", "text": "Caldwell-Luc Incision", "correct": false}, {"label": "B", "text": "Weber-Fergusson Incision", "correct": true}, {"label": "C", "text": "Modified Blair Incision", "correct": false}, {"label": "D", "text": "Lateral Rhinotomy Incision", "correct": false}], "correct_answer": "B. Weber-Fergusson Incision", "question_images": ["https://image.prepladder.com/content/5eCqWFOMsGr29PtmacZl1739247442.png"], "explanation_images": ["https://image.prepladder.com/content/SCxm6irCC0r7Ec4BNqzt1739247538.png", "https://image.prepladder.com/content/xLJTi5Vi4MAzHsMGH3YN1739247580.png", "https://image.prepladder.com/content/q30xBURCj7tUdiawjRGM1739247642.png", "https://image.prepladder.com/content/Z8gxb1tkjSHkdi95fQZ51739247725.png", "https://image.prepladder.com/content/d7MTChA0eJu37Wy2X7AL1739247806.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IhFr0MxM54lbVsHjEfFk1748262179.mp3", "video": ""}, {"text": "A 55-year-old male patient requires mandibular reconstruction following the resection of a tumor. The surgeon is considering different bone graft options. Which of the following bone grafts is not likely to be chosen for bony reconstruction of the mandible?", "options": [{"label": "A", "text": "Fibula bone graft", "correct": false}, {"label": "B", "text": "Iliac crest bone graft", "correct": false}, {"label": "C", "text": "Tibia bone graft", "correct": true}, {"label": "D", "text": "Scapula bone graft", "correct": false}], "correct_answer": "C. Tibia bone graft", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Gold Standard Flap Reconstruction with composite free flaps is considered the gold standard for segmental mandibular defects.</li><li>↳ Gold Standard Flap</li><li>↳ Gold Standard Flap</li><li>↳ Gold Standard Flap</li><li>↳ Reconstruction with composite free flaps is considered the gold standard for segmental mandibular defects.</li><li>↳ Reconstruction with composite free flaps is considered the gold standard for segmental mandibular defects.</li><li>↳ composite free flaps</li><li>↳ Choice of Flap Depends on defect site, size, complexity, patient comorbidities, and surgeon’s training and preference.</li><li>↳ Choice of Flap</li><li>↳ Choice of Flap</li><li>↳ Choice of Flap</li><li>↳ Depends on defect site, size, complexity, patient comorbidities, and surgeon’s training and preference.</li><li>↳ Depends on defect site, size, complexity, patient comorbidities, and surgeon’s training and preference.</li><li>↳ Anterior Defect More challenging to reconstruct than posterior defects; crucial for achieving satisfactory function.</li><li>↳ Anterior Defect</li><li>↳ Anterior Defect</li><li>↳ Anterior Defect</li><li>↳ More challenging to reconstruct than posterior defects; crucial for achieving satisfactory function.</li><li>↳ More challenging to reconstruct than posterior defects; crucial for achieving satisfactory function.</li><li>↳ Graft used (Options A, B &amp; D) Fibula Iliac crest Scapula Radius</li><li>↳ Graft used (Options A, B &amp; D)</li><li>↳ Graft used</li><li>↳ Graft used</li><li>↳ (Options A, B &amp; D)</li><li>↳ (Options A, B &amp; D)</li><li>↳ Fibula Iliac crest Scapula Radius</li><li>↳ Fibula Iliac crest Scapula Radius</li><li>↳ Fibula</li><li>↳ Iliac crest</li><li>↳ Scapula</li><li>↳ Radius</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:531px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gold Standard Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reconstruction with <strong>composite free flaps</strong> is considered the gold standard for <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> mandibular defects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Choice of Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> site, size, complexity, patient comorbidities, and surgeon’s training and preference.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More challenging to reconstruct than <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> defects; crucial for achieving satisfactory function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft used </strong></p>\n<p><strong>(Options A, B &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibula</li>\n<li>Iliac crest</li>\n<li>Scapula</li>\n<li>Radius</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/POR6pt7mL8sEAbCqT9Tp1748261984.mp3", "video": ""}, {"text": "A patient is scheduled for segmental mandibulectomy due to a lower alveolar tumor invading the mandible. Which statement accurately describes this procedure?", "options": [{"label": "A", "text": "Preserves mandible continuity.", "correct": false}, {"label": "B", "text": "Suitable for tumors not invading the mandible.", "correct": false}, {"label": "C", "text": "Removes the entire height of the mandible.", "correct": true}, {"label": "D", "text": "Resection of partial thickness of the mandible.", "correct": false}], "correct_answer": "C. Removes the entire height of the mandible.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aWU5hjEsPzf1bypyjsxX1739246991.png", "https://image.prepladder.com/content/v2HuJ3WZIXJBSa0oYnqC1739246963.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Segmental Mandibulectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Marginal Mandibulectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the full height of the invaded section of the mandible. <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of a partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the mandible. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuity of mandible</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> of the lower border.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuity of the lower border remains intact. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invading the mandible, often through the <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> root leading into the mandibular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> and <span class=\"customMeta\" data-dictid=\"5f96e2a37016927771834373e8902b\">cancellous</span> bone.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is close to the <span class=\"customMeta\" data-dictid=\"55c062d44f16927771919375042b03\">mandible</span> but does not invade it. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Sushma Mehta, Moni Abraham Kuriakose\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Types-of-mandibulectomies-a-marginal-and-b-segmental_fig10_349396683\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/aWU5hjEsPzf1bypyjsxX1739246991.png\" width=\"300\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<img alt=\"\" data-author=\"Sushma Mehta, Moni Abraham Kuriakose\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Types-of-mandibulectomies-a-marginal-and-b-segmental_fig10_349396683\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/v2HuJ3WZIXJBSa0oYnqC1739246963.png\" width=\"350\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/q26suJALVgBfPgdHhodu1747154291.mp3", "video": ""}, {"text": "A 65-year-old male with lower alveolar squamous cell carcinoma presents with an ulcerated mass, extensive cortical bone erosion, invasion beyond the inferior alveolar canal, and palpable submandibular lymph nodes. What is the most appropriate treatment?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Local excision with marginal resection", "correct": false}, {"label": "C", "text": "Segmental mandibulectomy", "correct": true}, {"label": "D", "text": "Marginal resection, along with block dissection", "correct": false}], "correct_answer": "C. Segmental mandibulectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mhMonbAJt6ZmFDUsZQy11739246793.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/K8UgH1bT44zYaM77eXGy1748248089.mp3", "video": ""}, {"text": "A patient presents with 2.5 cm ulceroproliferative adenoid cystic carcinoma on the left side of the hard palate. Imaging shows no evidence of bone invasion or lymph node involvement. Which of the following is the most appropriate management strategy?", "options": [{"label": "A", "text": "Wide local excision with frozen section control", "correct": false}, {"label": "B", "text": "Partial maxillectomy with ipsilateral neck dissection", "correct": false}, {"label": "C", "text": "Partial maxillectomy without neck dissection", "correct": true}, {"label": "D", "text": "Radiotherapy alone", "correct": false}], "correct_answer": "C. Partial maxillectomy without neck dissection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carcinoma of the Hard Palate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumors in the <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> are often malignant, with <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> being common.</li>\n<li><strong>Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> carcinoma</strong>: Present as a single, solid, smooth <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> with an <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> on the summit.</li>\n<li><strong>Squamous cell carcinoma</strong>:<strong> </strong>Characterized by an <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with raised and everted edges.</li>\n<li>Upper deep <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes are involved in 25% of cases.</li>\n<li>Malignant tumors can invade the periosteum, bone, maxilla, sinus, or nose.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reverse smokers have higher risk of <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> due to repeated <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> injury from smoking rolled tobacco (Churat).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wedge biopsy</li>\n<li>FNAC <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</li>\n<li>CT Scan: To check for tumor extensions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with removal of the underlying <span class=\"customMeta\" data-dictid=\"733f60c2581692777194690224e6eb\">palatal</span> bone.</li>\n<li><strong>Maxillectomy:</strong> Partial or total, often done using the <strong>Weber-Ferguson incision</strong>.</li>\n<li>Reconstruction: With a <span class=\"customMeta\" data-dictid=\"730fafcc78169277719319b79378c3\">myocutaneous</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> and <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> prosthesis.</li>\n<li>Postoperative <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> and neck block <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> are often required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HiyQblB4vRUYoZetq3NE1748247907.mp3", "video": ""}, {"text": "A female who chews betel quid has pale, fibrous oral mucosa and a 2 cm interincisal opening. Biopsy revealed increased collagen deposition in the lamina propria. Which of the following is the most likely complication of this condition if left untreated?", "options": [{"label": "A", "text": "Candidiasis", "correct": false}, {"label": "B", "text": "Malignant transformation", "correct": true}, {"label": "C", "text": "Bilateral submandibular gland hypertrophy", "correct": false}, {"label": "D", "text": "Spontaneous remission of fibrosis", "correct": false}], "correct_answer": "B. Malignant transformation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precipitating Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smoking</li>\n<li>Spirit</li>\n<li>Syphilis</li>\n<li>Sharp tooth</li>\n<li>Sepsis</li>\n<li>Spices</li>\n<li>Betel Nut Chewing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Premalignant Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Leukoplakia</li>\n<li>Oral <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> fibrosis</li>\n<li>Erythroplakia</li>\n<li>Sideropenic dysphagia</li>\n<li>Chronic hyperplastic candidiasis</li>\n<li>Syphilitic glossitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> in cheek initially</li>\n<li>Pain: Develops when the <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> involves skin, bone, or becomes secondarily infected</li>\n<li>Halitosis</li>\n<li>Retromolar <span class=\"customMeta\" data-dictid=\"d89806ebbe1692777200b7b677e616\">trigone</span> involvement: Indicates advanced disease</li>\n<li>Trismus and dysphagia</li>\n<li>Fungating lesion: Tumor breaking through the skin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wedge Biopsy: Taken from the edge of the ulcer</li>\n<li>FNAC: For <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> assessment</li>\n<li>CT/MRI: To assess tumor extent</li>\n<li>Orthopantomogram (OPG): Assess mandibular involvement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery:\n\t\t\t\t<ul>\n<li>Wide excision: Removal of the tumor with a 1-2 cm margin.</li>\n<li>Hemimandibulectomy: Performed when the tumor involves the mandible.</li>\n<li>Neck <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection: Radical or modified radical <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> depending on <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement.</li>\n</ul>\n</li>\n<li>Radiotherapy:\n\t\t\t\t<ul>\n<li>Curative or palliative: <span class=\"customMeta\" data-dictid=\"61c2938b191692777183fbbe51a17c\">Brachytherapy</span> or external radiotherapy.</li>\n<li>Pre-op radiotherapy: Given to shrink fixed <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, making them operable.</li>\n<li>Post-op radiotherapy: For T3/T4 tumors or N2/N3 nodal status to reduce recurrence.</li>\n</ul>\n</li>\n<li>Chemotherapy:\n\t\t\t\t<ul>\n<li>Pre-operative to downstage tumors.</li>\n<li>Post-operative to improve outcomes.</li>\n<li>Chemoradiotherapy for unresectable tumors.</li>\n<li>Drugs Used: Methotrexate, cisplatin, vincristine, bleomycin, adriamycin.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lwXeUjknX6PUroA550jA1748247701.mp3", "video": ""}, {"text": "Which of the following statements about the extent of the oral cavity is false?", "options": [{"label": "A", "text": "The anterior border of the oral cavity begins at the vermillion border.", "correct": false}, {"label": "B", "text": "Superiorly, the oral cavity includes the soft palate up to the uvula.", "correct": true}, {"label": "C", "text": "The posterior extent of the oral cavity ends at the circumvallate papillae of the tongue.", "correct": false}, {"label": "D", "text": "The tonsils are not a part of the oral cavity.", "correct": false}], "correct_answer": "B. Superiorly, the oral cavity includes the soft palate up to the uvula.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4Y15xn5qY6Y6B2156CGE1739201210.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UW4nT3W3r6TGAkMETrVz1748243297.mp3", "video": ""}, {"text": "A 65-year-old patient presents with a 2.5 cm ulcerative lesion on the right side of his lower lip confirmed as squamous cell carcinoma. Which of the following statements is correct regarding the primary lymphatic drainage and surgical management of this lesion?", "options": [{"label": "A", "text": "Drains to submental nodes; level I neck dissection is sufficient.", "correct": false}, {"label": "B", "text": "Drains to ipsilateral submandibular nodes; levels I-III neck dissection is recommended.", "correct": true}, {"label": "C", "text": "High risk of contralateral metastasis; bilateral neck dissection is needed.", "correct": false}, {"label": "D", "text": "Drains to preauricular and parotid nodes; requires superficial parotidectomy.", "correct": false}], "correct_answer": "B. Drains to ipsilateral submandibular nodes; levels I-III neck dissection is recommended.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>UV radiation exposure</li>\n<li>Tobacco use</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> (e.g., ill-fitting dentures)</li>\n<li>Immunosuppression</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"70ae0d8a1f1692777194515e8836a4\">papillomavirus</span> (HPV) infection</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions (e.g., <span class=\"customMeta\" data-dictid=\"8e97b73dae1692777180afeb1d2e50\">actinic</span> cheilitis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-healing progressive painless ulcer</li>\n<li>Everted edge with indurations</li>\n<li>Growth moves with the lip</li>\n<li>Submental, <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> and upper deep neck nodes may get enlarged.</li>\n<li>Tender firm <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes may be due to infection; hard initially non-tender nodes are due to <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> spread.</li>\n<li>Fungation, bleeding, halitosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wedge biopsy</li>\n<li>FNAC of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>CT/MRI head and neck</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Early Stage (T1-T2N0):</strong></li>\n</ol>\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with 1 cm margins</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for tumors &gt;2 cm or &gt;4 mm depth</li>\n<li>Reconstruction: Primary closure, local flaps, or skin grafts</li>\n</ul>\n\t\t\t \n\n\t\t\t<ol>\n<li><strong>Advanced Stage (T3-T4 or N+):</strong></li>\n</ol>\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with ≥1 cm margins</li>\n<li>Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> (comprehensive or selective based on nodal status)</li>\n<li>Complex <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> (local/regional flaps, free tissue transfer)</li>\n<li>Adjuvant <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> or <span class=\"customMeta\" data-dictid=\"00cc356fdf1692777184c13ad34d10\">chemoradiotherapy</span> based on <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> findings</li>\n</ul>\n\t\t\t \n\n\t\t\t<ol>\n<li><strong>Management of the Neck:</strong></li>\n</ol>\n<ul>\n<li>Elective neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for high-risk tumors (&gt;2 cm, &gt;4 mm depth)</li>\n<li>Therapeutic neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for clinically positive nodes</li>\n<li><strong>Levels typically addressed: I-III for N0 neck, I-V for N+ neck</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zkQrNjyy9Hpwie0hveaE1748247270.mp3", "video": ""}, {"text": "A 72-year-old farmer presents with a 3.5 cm exophytic lesion on his lower lip. Biopsy confirms well-differentiated squamous cell carcinoma with 8 mm depth of invasion. There are no palpable lymph nodes. Which of the following is the correct management strategy?", "options": [{"label": "A", "text": "Wide local excision with 5 mm margins and neck observation.", "correct": false}, {"label": "B", "text": "Wide local excision with 1 cm margins and ipsilateral neck dissection.", "correct": true}, {"label": "C", "text": "Wide local excision with 1 cm margins and bilateral neck dissection.", "correct": false}, {"label": "D", "text": "Radiotherapy alone.", "correct": false}], "correct_answer": "B. Wide local excision with 1 cm margins and ipsilateral neck dissection.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7qjH76a4O1wSgR0Tgtkm1739246095.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:431px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T Stage</strong>:</p>\n<ul>\n<li><strong>Tis: </strong>Carcinoma in situ</li>\n<li><strong>T1</strong>: Tumor ≤2 cm and ≤5 mm depth of invasion</li>\n<li><strong>T2</strong>: Tumor ≤2 cm and &gt;5 mm but ≤10 mm depth, <strong>OR</strong><br/>\n\t\t\t\tTumor &gt;2 cm but ≤4 cm and ≤10 mm depth</li>\n<li><strong>T3</strong>: Tumor &gt;4 cm <strong>OR</strong> any tumor &gt;10 mm depth of invasion</li>\n<li><strong>T4</strong>: Invasion of adjacent structures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N Stage:</strong></p>\n<ul>\n<li><strong>N0:</strong> No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</li>\n<li><strong>N1-N3</strong>: Based on number, size, and <span class=\"customMeta\" data-dictid=\"135a4fca481692777191e4ccc16a44\">laterality</span> of involved nodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M Stage:</strong></p>\n<ul>\n<li><strong>M0: </strong>No distant metastasis</li>\n<li><strong>M1: </strong>Distant metastasis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Stage (T1-T2N0)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with 1 cm margins</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for tumors &gt;2 cm or &gt;4 mm depth</li>\n<li>Reconstruction: Primary closure, local flaps, or skin grafts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advanced Stage (T3-T4 or N+)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with ≥1 cm margins</li>\n<li>Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> (comprehensive or selective based on nodal status)</li>\n<li>Complex <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> (local/regional flaps, free tissue transfer)</li>\n<li>Adjuvant <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> or <span class=\"customMeta\" data-dictid=\"00cc356fdf1692777184c13ad34d10\">chemoradiotherapy</span> based on <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> findings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reconstruction Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wedge <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (for small lesions)</li>\n<li>Local flaps: <strong>Abbe-Estlander, Karapandzic, nasolabial</strong></li>\n<li>Regional flaps: Forehead, cervicofacial</li>\n<li>Free tissue transfer: <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">Radial</span> <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> free flap, <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> thigh flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of the Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elective neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for high-risk tumors (&gt;2 cm, &gt;4 mm depth)</li>\n<li>Therapeutic neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for clinically positive nodes</li>\n<li><strong>Levels typically addressed: I-III for N0 neck, I-V for N+ neck</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adjuvant: For positive margins, <span class=\"customMeta\" data-dictid=\"849a50eb4a1692777195de19bee5ed\">perineural</span> invasion, multiple positive nodes</li>\n<li>Definitive: For patients unfit for surgery or refusing surgery</li>\n<li>Brachytherapy: Can be considered for select early-stage lesions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not routinely used in early-stage disease</li>\n<li>May be combined with <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> in locally advanced cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follow-up and Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular follow-up visits: Every 1-3 months for the first year, then gradually decreasing frequency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oUuoaaYLX2B6bIYjaRno1748247099.mp3", "video": ""}, {"text": "A 62-year-old male with recurrent squamous cell carcinoma of the oral cavity is being considered for immunotherapy using pembrolizumab. Which of the following correctly describes the mechanism of action of the drug?", "options": [{"label": "A", "text": "Inhibits VEGF to prevent tumor angiogenesis", "correct": false}, {"label": "B", "text": "Blocks PD-1 receptor, enhancing T-cell anti-tumor activity", "correct": true}, {"label": "C", "text": "Targets EGFR to inhibit tumor cell proliferation", "correct": false}, {"label": "D", "text": "Activates NK cells to induce antibody-dependent cellular cytotoxicity", "correct": false}], "correct_answer": "B. Blocks PD-1 receptor, enhancing T-cell anti-tumor activity", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/f1g25XjwmF5s2YcJivO31748246926.mp3", "video": ""}, {"text": "A 59-year-old male with T2N2bM0 squamous cell carcinoma of the buccal mucosa underwent surgery. The postoperative histopathology report reveals close surgical margin (&amp;lt; 5 mm) and extracapsular extension in two lymph nodes. What is the most appropriate adjuvant treatment for this patient?", "options": [{"label": "A", "text": "Radiotherapy alone", "correct": false}, {"label": "B", "text": "Chemotherapy alone", "correct": false}, {"label": "C", "text": "Concurrent chemoradiotherapy", "correct": true}, {"label": "D", "text": "Observation and close follow-up", "correct": false}], "correct_answer": "C. Concurrent chemoradiotherapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy alone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate risk features:</p>\n<ul>\n<li>T3 or T4a primary tumors</li>\n<li>N2 or N3 nodal disease (without <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">extracapsular</span> extension)</li>\n<li>Perineural invasion</li>\n<li>Lymphovascular invasion</li>\n<li>Single <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> &gt;3 cm or multiple positive nodes</li>\n<li>Close margins (between 5mm and 1cm)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Concurrent chemoradiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-risk features:</p>\n<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> margins</li>\n<li>Extracapsular extension of nodal disease</li>\n<li>T4b tumors</li>\n<li>N3 nodal disease</li>\n<li>Multiple positive nodes with <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">extracapsular</span> extension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specific indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>pT3 or pT4 primary tumors</li>\n<li>N2 or N3 neck disease</li>\n<li>Perineural invasion</li>\n<li>Vascular embolism</li>\n<li>Lymphatic invasion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Considerations for <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> addition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age &lt;70 years</li>\n<li>Good performance status</li>\n<li>No significant comorbidities</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CF4tt4fQzhELmCuWIMXn1748246709.mp3", "video": ""}, {"text": "A 58-year-old male with a 6 cm x 4 cm defect involving more than 50% of the tongue after excision for a T3N1M0 squamous cell carcinoma needs reconstruction. Which of the following flaps would be most appropriate for reconstruction for this patient?", "options": [{"label": "A", "text": "Radial forearm free flap", "correct": true}, {"label": "B", "text": "Anterolateral thigh free flap", "correct": false}, {"label": "C", "text": "Pectoralis major myocutaneous flap", "correct": false}, {"label": "D", "text": "Supraclavicular artery island flap", "correct": false}], "correct_answer": "A. Radial forearm free flap", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WfoxVQDQ4CVYqgThSFql1739245587.png", "https://image.prepladder.com/content/o6n5g0tqoNVkXM4GeQLC1739245671.png", "https://image.prepladder.com/content/ALUztkHOGvVHOquVxBOc1739245746.png", "https://image.prepladder.com/content/5Ip4gAotpnA4AGwwbeFk1739245819.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HqUFQsVirAvukIR9uQPd1748246487.mp3", "video": ""}, {"text": "A 62-year-old male presents with a T2N1M0 squamous cell carcinoma of the lateral border of the tongue. According to the latest National Comprehensive Cancer Network (NCCN) guidelines, what is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Wide local excision of the primary tumor only.", "correct": false}, {"label": "B", "text": "Definitive radiotherapy with concurrent chemotherapy.", "correct": false}, {"label": "C", "text": "Surgery followed by adjuvant radiotherapy.", "correct": true}, {"label": "D", "text": "Neoadjuvant chemotherapy followed by surgery.", "correct": false}], "correct_answer": "C. Surgery followed by adjuvant radiotherapy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:535px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early-stage (I-II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery is the mainstay of treatment. <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">Radiotherapy</span> can be an alternative in select cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locally advanced (III-IVA/B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Resectable: Surgery followed by <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> therapy (radiotherapy or chemoradiotherapy) based on <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> risk factors.</li>\n<li>Unresectable: <span class=\"customMeta\" data-dictid=\"a45b36c1c716927771840ee63f1cba\">Concurrent</span> <span class=\"customMeta\" data-dictid=\"00cc356fdf1692777184c13ad34d10\">chemoradiotherapy</span> or <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> alone for patients unfit for chemotherapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metastatic (IVC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palliative chemotherapy, immunotherapy, or best supportive care.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dz96uYB3drS7RSKDTatd1748246325.mp3", "video": ""}, {"text": "A male presents with a painful 2.5 cm ulceroproliferative growth on the right lateral border of the tongue with induration extending to the floor of the mouth and a single, firm, mobile 1.5 cm lymph node palpable in the right submandibular region. The CT scan shows no mandible or extrinsic muscle involvement. What is the correct TNM staging for this patient?", "options": [{"label": "A", "text": "T2N1M0", "correct": false}, {"label": "B", "text": "T3N1M0", "correct": true}, {"label": "C", "text": "T4aN1M0", "correct": false}, {"label": "D", "text": "T2N2aM0", "correct": false}], "correct_answer": "B. T3N1M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T (Primary Tumor):</strong></p>\n<ul>\n<li>Tx: Primary tumor cannot be assessed.</li>\n<li>Tis: <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> in situ.</li>\n<li>T1: Tumor ≤2 cm, ≤5 mm depth of invasion (DOI).</li>\n<li>T2: Tumor ≤2 cm, DOI &gt;5 mm and ≤10 mm; or tumor &gt;2 cm but ≤4 cm, and ≤10 mm DOI.</li>\n<li>T3: Tumor &gt;4 cm; or any tumor &gt;10 mm DOI.</li>\n<li>T4a: Moderately advanced local disease - Invades through <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bone, deep/ <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, maxillary sinus, or skin of the face.</li>\n<li>T4b: Very advanced local disease - Invades masticator space, <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates, skull base, or encases internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N (Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes):</strong></p>\n<ul>\n<li>Nx: Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</li>\n<li>N0: No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</li>\n<li>N1: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, ≤3 cm in greatest dimension.</li>\n<li>N2:\n\t\t\t\t<ul>\n<li>N2a: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> node, &gt;3 cm but ≤6 cm in greatest dimension.</li>\n<li>N2b: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> nodes, all ≤6 cm).</li>\n<li>N2c: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, all ≤6 cm.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>N3:\n\t\t\t\t<ul>\n<li>N3a: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> &gt;6 cm in greatest dimension, ENE(-).</li>\n<li>N3b: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in any node(s) with clinically overt ENE(+).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M (Distant Metastasis):</strong></p>\n<ul>\n<li>M0: No distant metastasis</li>\n<li>M1: Distant metastasis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:320px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1 N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2 N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3 N0 M0 or T1-3 N1 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a N0-1 M0 or T1-4a N2 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any T N3 M0 or T4b Any N M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any T Any N M1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jW34GsOeTrxmvvi6DjMx1746106966.mp3", "video": ""}, {"text": "A 55-year-old patient presents with a non-healing ulcer in the oral cavity and is diagnosed with carcinoma oral cavity. Which of the following statements regarding carcinoma oral cavity is most accurate?", "options": [{"label": "A", "text": "Distant metastasis is common.", "correct": false}, {"label": "B", "text": "Ulcer lasting over 2 weeks is significant.", "correct": true}, {"label": "C", "text": "Adenocarcinoma is the most common oral cancer.", "correct": false}, {"label": "D", "text": "Oral carcinoma is the least common among head and neck tumors.", "correct": false}], "correct_answer": "B. Ulcer lasting over 2 weeks is significant.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Non-healing <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> (&gt;2 weeks duration) (Option B)</strong></li>\n<li>Persistent neck swelling/ lymphadenopathy</li>\n<li>Pigmented <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with a progressive increase in size</li>\n<li>Lesion with associated induration</li>\n<li>Soft-tissue <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with associated radiographic changes</li>\n<li>Unexplained tooth mobility</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sensory nerve deficit</li>\n<li>Chronic otalgia</li>\n<li>Trismus of unknown etiology</li>\n<li>Dysphagia</li>\n<li>Sore tongue</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oNV1sjj0nZIwLGC3ty8W1748246189.mp3", "video": ""}, {"text": "A patient who had developed a buccal squamous cell carcinoma was treated by complete resection and radiation therapy. After his treatment was completed and he had clear margins after the resection, he developed a new tumor in his oral cavity on his tongue. What is the basis of this development of a second primary tumor?", "options": [{"label": "A", "text": "Field defect", "correct": false}, {"label": "B", "text": "Field effect", "correct": false}, {"label": "C", "text": "Field cancerization", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iKSs6HnvJwVZVWpTuk8e1748246018.mp3", "video": ""}, {"text": "A 45-year-old female comes to the clinic with a reddish patch on her tongue, as shown in the figure. She gives a history of chewing pan masala for more than 15 years. She has no difficulty in opening her mouth and has no other comorbidities. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Oral submucosal fibrosis", "correct": false}, {"label": "B", "text": "Erythroplakia", "correct": true}, {"label": "C", "text": "Plummer-Vinson syndrome", "correct": false}, {"label": "D", "text": "Leukoerythroplakia", "correct": false}], "correct_answer": "B. Erythroplakia", "question_images": ["https://image.prepladder.com/content/HvEBI3ocN4MdMvd6XfUI1739203790.png"], "explanation_images": ["https://image.prepladder.com/content/zY8HOkrNDnTqk5RI6x6J1739203937.png", "https://image.prepladder.com/content/V56I0cjhIzO1eltEkpDo1739203953.png", "https://image.prepladder.com/content/5NXyI4veLpBOW8dR34Kw1739204495.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/EWo06MlLJ14kOAk7V4BQ1748245934.mp3", "video": ""}, {"text": "A 50-year-old patient comes to the OPD concerned about a newly developed whitish discolouration in his mouth. On examination, a white plaque-like lesion was found in his buccal mucosa, which could not be rubbed off. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Leukoplakia", "correct": true}, {"label": "B", "text": "Erythroplakia", "correct": false}, {"label": "C", "text": "Speckled leukoplakia", "correct": false}, {"label": "D", "text": "Chronic hyperplastic Candidiasis", "correct": false}], "correct_answer": "A. Leukoplakia", "question_images": ["https://image.prepladder.com/content/hw7CJhzWXEV2lq2DK1221739201388.png"], "explanation_images": ["https://image.prepladder.com/content/Oy6UeaGtL4ncim1O4v1G1739201492.png", "https://image.prepladder.com/content/Sn0a4xypgiDQXgkqf5Mt1739201574.png", "https://image.prepladder.com/content/jkl9Bj8CKIQAy5JCehUT1739201652.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leukoplakia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"39ca145a0f1692777183a33d06e96d\">candidiasis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Premalignant lesion</li>\n<li>Causes: Pan masala chewing, Tobacco chewing, <span class=\"customMeta\" data-dictid=\"4b63b4a64c1692777182b509b257e2\">Betel</span> quid</li>\n<li>Can be seen in adults above 40 years.</li>\n<li>White patch or plaque</li>\n<li>Surgical excision, CO<sub>2</sub> laser, and medications can be used to treat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Premalignant lesion</li>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\">Candida</span> albicans</li>\n<li>Seen in immunosuppressed</li>\n<li>White curdy lesions</li>\n<li>Treated by <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals, surgery, or lasers.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Aci4ckqonADkJOefEUbL1748245783.mp3", "video": ""}, {"text": "A 45-year-old male comes to the hospital after noticing abnormal growth on the right side of his mouth. He has had a habit of smoking and chewing betel quid for more than 20 years. On further evaluation, he also gives a history of a red lesion present in the same location before the current state. Which of the following, in this case, is not a risk factor for oral carcinoma?", "options": [{"label": "A", "text": "Age above 40 years", "correct": true}, {"label": "B", "text": "Erythroplakia", "correct": false}, {"label": "C", "text": "Smoking", "correct": false}, {"label": "D", "text": "Betel quid", "correct": false}], "correct_answer": "A. Age above 40 years", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hBnPmVqx8kkthddxSMCE1748245675.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 36 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 60 y/o male suddenly experiences an intense headache, described as the worst headache of his life, followed by vomiting and photophobia. O/E he has neck stiffness and a dilated pupil on the right side. A CT scan reveals bleeding in the subarachnoid space. Which of the following is the most common cause of this condition?", "options": [{"label": "A", "text": "Hypertension", "correct": false}, {"label": "B", "text": "Intracranial aneurysm", "correct": true}, {"label": "C", "text": "Arteriovenous malformation (AVM)", "correct": false}, {"label": "D", "text": "Brain tumour", "correct": false}], "correct_answer": "B. Intracranial aneurysm", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which specific nerve is affected in Frey's syndrome?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Oculomotor nerve", "correct": false}, {"label": "C", "text": "Auriculotemporal nerve", "correct": true}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": false}], "correct_answer": "C. Auriculotemporal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hDXfdQMTlOhJqA44MKck1687773809.png", "https://image.prepladder.com/content/fcvb0hxuydLPQJ54zSYV1687773813.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient comes with a gradually increasing enlargement for the past one and a half years. Upon examination, the swelling demonstrates inconsistency in texture and matches the appearance depicted in the provided image. What is the likely underlying reason for this?", "options": [{"label": "A", "text": "Jaw Tumour", "correct": false}, {"label": "B", "text": "Dermoid cyst", "correct": false}, {"label": "C", "text": "Pleomorphic adenoma", "correct": true}, {"label": "D", "text": "Sebaceous cyst", "correct": false}], "correct_answer": "C. Pleomorphic adenoma", "question_images": ["https://image.prepladder.com/content/LSlvfRnqrSK0l0iWjHUS1691507302.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common oral cancer is:", "options": [{"label": "A", "text": "Adenocarcinoma", "correct": false}, {"label": "B", "text": "Transition cell CA", "correct": false}, {"label": "C", "text": "Mucoepidermoid", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": true}], "correct_answer": "D. Squamous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\"&gt;Squamous&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests would a surgeon advise first in a patient with a large thyroid swelling?", "options": [{"label": "A", "text": "Ultrasound of the neck", "correct": true}, {"label": "B", "text": "FNAC", "correct": false}, {"label": "C", "text": "Biopsy", "correct": false}, {"label": "D", "text": "Radioiodine uptake", "correct": false}], "correct_answer": "A. Ultrasound of the neck", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NfwDhGcurpb9NR63k0fZ1746983730.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A car driver was brought into the A &amp;amp; E following a RTA with complaints of breathlessness. On examination, his vitals are PR-112/min, BP-100/70, SpO2-90 %, and there is extensive bruising on his chest. What is the management of this patient?", "options": [{"label": "A", "text": "Chest tube drainage", "correct": true}, {"label": "B", "text": "24% oxygen", "correct": false}, {"label": "C", "text": "IPPV", "correct": false}, {"label": "D", "text": "Internal operative fixation of the fracture’s segments", "correct": false}], "correct_answer": "A. Chest tube drainage", "question_images": ["https://image.prepladder.com/content/JvtCrMXOc4WSXSsc3FWi1746983600.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Flail chest </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It occurs when<strong> three or more consecutive ribs</strong> are fractured in at least <strong>two places</strong>, creating a <span class=\"customMeta\" data-dictid=\"3dec14fe921692777202dc55958a46\">flail</span> segment that moves independently.</li>\n<li>It exhibits <strong>paradoxical chest movement</strong> (inwards during <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> &amp; outwards during exhalation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypoventilation: Reduced lung <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> leads to low oxygen and high CO₂ levels.</li>\n<li>Mediastinal Flutter: Abnormal <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> movement risks sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</li>\n<li>Pendular Air Movement: Inefficient air exchange between lungs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemothorax: Blood in the chest cavity.</li>\n<li>Pneumothorax: Air in the chest cavity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ventilation Support:\n\t\t\t\t<ul>\n<li><strong>Oxygen supplementation and Analgesics- </strong>Initial management</li>\n<li><strong>IPPV</strong> is the preferred TOC.</li>\n<li><strong>Tracheostomy</strong> if support exceeds 10 days.</li>\n</ul>\n</li>\n<li>Injury Management:\n\t\t\t\t<ul>\n<li><strong>Intercostal Tube Drainage</strong>: Removes air/fluids from the pleural space.</li>\n<li><strong>Rib Fixation</strong>: Stabilises the chest wall.</li>\n</ul>\n</li>\n<li>Supportive Care:\n\t\t\t\t<ul>\n<li><strong>Blood Transfusions</strong>: For blood loss.</li>\n<li><strong>IV Fluids</strong>: For hydration.</li>\n<li><strong>Antibiotics</strong>: To prevent infection.</li>\n<li><strong>Medications</strong>: Bronchodilators and steroids.</li>\n</ul>\n</li>\n<li>Thoracotomy:\n\t\t\t\t<ul>\n<li>Considered in severe cases</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement regarding retrosternal goitre is accurate?", "options": [{"label": "A", "text": "Operated in all patients regardless of symptoms", "correct": false}, {"label": "B", "text": "Sternal incision is always required to operate", "correct": false}, {"label": "C", "text": "It receives blood supply from the thoracodorsal artery", "correct": false}, {"label": "D", "text": "Most of the retrosternal goitres can be removed by a neck incision", "correct": true}], "correct_answer": "D. Most of the retrosternal goitres can be removed by a neck incision", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Most of the &lt;span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\"&gt;retrosternal&lt;/span&gt; goitres can be removed by a neck incision:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Retrosternal goitre</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> that extends into the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> behind the Sternum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary: </strong>Ectopic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tissue in the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> (10%)</li>\n<li><strong>Secondary: </strong>Starts from neck and extends retrosternally (90%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Neck <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> Symptoms: </strong>Difficulty breathing (tracheal compression) and <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (esophageal compression).</li>\n<li><strong>Pemberton Sign:</strong> <strong>Facial flushing</strong> and increased difficulty breathing when <strong>raising the arms</strong> due to <strong>thoracic <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> compression.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Physical examination:</strong> Limited <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of the lower border of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> swelling.</li>\n<li><strong>Imaging:</strong> <strong>Computed <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (CT) Scan of the Neck and Chest</strong> is <strong>IOC</strong> to assess the extent of <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> involvement and to evaluate <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of surrounding structures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary / <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> / Large <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">Retrosternal</span> <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">Goiter</span> - <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> <span class=\"customMeta\" data-dictid=\"012f2d780116927771993e010149ac\">Sternotomy</span> (Option B ruled out)</strong></li>\n<li><strong>Secondary <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">Retrosternal</span> <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">Goiter</span> - <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> / Neck Incision</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the definition of the Miami criteria regarding intraoperative parathyroid hormone (PTH) measurement among the options listed below?", "options": [{"label": "A", "text": "Quarter fall in 5 min", "correct": false}, {"label": "B", "text": "Quarter fall in 10 min", "correct": false}, {"label": "C", "text": "Half fall in 5 min", "correct": false}, {"label": "D", "text": "Half fall in 10 min", "correct": true}], "correct_answer": "D. Half fall in 10 min", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures is most likely to be injured, leading to lower lip paralysis in a 30-year-old teacher who underwent parotidectomy?", "options": [{"label": "A", "text": "Temporal branch of the facial nerve", "correct": false}, {"label": "B", "text": "Cervical branch of facial nerve", "correct": false}, {"label": "C", "text": "Parotid duct", "correct": false}, {"label": "D", "text": "Mandibular branch of facial nerve", "correct": true}], "correct_answer": "D. Mandibular branch of facial nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Complications of Parotidectomy:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Temporary <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Palsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mostly the lower branches of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve - the marginal mandibular nerve.</li>\n<li>Most patients recover over time.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Infection </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rare, as <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">parotidectomy</span> is a clean procedure.</li>\n<li>Aseptic precautions and timely drain removal reduce the risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hematoma Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uncommon.</li>\n<li>Careful <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">hemostasis</span> can prevent it.</li>\n<li>Larger hematomas may indicate a <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorder and require management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sialocele Formation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs if the main ductal system is exposed.</li>\n<li>Preventable with <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> dissection.</li>\n<li>Treatment: Anticholinergics, aspiration, and pressure dressings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Retromandibular area hollowing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Can occur post-surgery</li>\n<li>Reduced by placing <span class=\"customMeta\" data-dictid=\"0a266da66816927771824d58668832\">autologous</span> fat grafts during the surgery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Frey’s Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Also known as gustatory sweating;</li>\n<li>Caused by the<strong> cross-innervation</strong> of sweat glands by regenerating nerve fibres of the <span class=\"customMeta\" data-dictid=\"c2c10e783c1692777182a1d84457f9\">auriculotemporal</span> nerve.</li>\n<li><strong>For mild cases</strong>: Give antiperspirants;</li>\n<li><strong>Severe cases:</strong> <span class=\"customMeta\" data-dictid=\"3cb8b8422c16927771836b57b4c79e\">Botulinum toxin</span> injections or <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> neurectomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Permanent <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Nerve Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>D/t <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve during the surgery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Facial Numbness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Permanent <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> of the earlobe,</li>\n<li>D/t <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> of the great <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve during the surgery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The false statement about cystic masses of the neck is:", "options": [{"label": "A", "text": "Type 3 branchial fistula has its internal orifice on cricopharynxgeus", "correct": true}, {"label": "B", "text": "Cystic hygroma is filled with clear lymph", "correct": false}, {"label": "C", "text": "Thyroglossal cyst moves upwards on swallowing, and tongue protrusion", "correct": false}, {"label": "D", "text": "Fluctuation is positive in branchial cyst", "correct": false}], "correct_answer": "A. Type 3 branchial fistula has its internal orifice on cricopharynxgeus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\"&gt;Type 3&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cb3fde922016927771830912ac2fcf\"&gt;branchial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\"&gt;fistula&lt;/span&gt; has its internal &lt;span class=\"customMeta\" data-dictid=\"1aca482e7e169277719443d10dbe5f\"&gt;orifice&lt;/span&gt; on cricopharynxgeu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient who is a chronic tobacco chewer presents with a whitish lesion on the gingivobuccal sulcus for 7 months. What is the next best step in the management of this condition?", "options": [{"label": "A", "text": "Local excision and biopsy", "correct": true}, {"label": "B", "text": "Avoid smoking + Wait and watch", "correct": false}, {"label": "C", "text": "Steroidal injection", "correct": false}, {"label": "D", "text": "Sclerotherapy", "correct": false}], "correct_answer": "A. Local excision and biopsy", "question_images": ["https://image.prepladder.com/content/PxcoNCGs7xiVVLAPRt3Y1746171515.png"], "explanation_images": ["https://image.prepladder.com/content/OBFU3UFwdBxF1HzacKq81746171542.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>It is a progressive condition involving deep <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> in the oral mucosa, characterized by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> bands and considered a precancerous lesion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypersensitivity to tobacco, <span class=\"customMeta\" data-dictid=\"4b63b4a64c1692777182b509b257e2\">betel</span> nut, <strong>chilli</strong>, <span class=\"customMeta\" data-dictid=\"14dc9988461692777182be518d4bb7\">areca</span> nut, vitamin deficiencies, localised <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> disorders.</li>\n<li>Leads to alteration of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> causing juxtaepithelial progressive <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> of the submucosa.</li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> and dysplasia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in Asians</li>\n<li>Males and females are equally affected.</li>\n<li>Soreness in the mouth more during meals</li>\n<li>Burning, also more while eating</li>\n<li>Vesicular eruptions</li>\n<li>Trismus</li>\n<li>Difficulty in protruding tongue</li>\n<li>Fibrosis and scarring</li>\n<li>Ankylosing glossitis</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cessation of <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> factors(tobacco, chilli, <span class=\"customMeta\" data-dictid=\"14dc9988461692777182be518d4bb7\">areca</span> nut)</li>\n<li>Oral hygiene</li>\n<li>Dexamethasone local injections</li>\n<li>Hydrocortisone</li>\n<li>HCG <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> injection</li>\n<li>Vitamin and iron supplementation</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with graft</li>\n<li>Stem cell therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male patient presents with a swelling in the midline of his neck that shifts when he swallows or sticks out his tongue. What is the probable diagnosis?", "options": [{"label": "A", "text": "Brachial cyst", "correct": false}, {"label": "B", "text": "Thyroglossal cyst", "correct": true}, {"label": "C", "text": "Plunging ranula", "correct": false}, {"label": "D", "text": "Dermoid cyst", "correct": false}], "correct_answer": "B. Thyroglossal cyst", "question_images": ["https://image.prepladder.com/content/En3ZFxvrXhAZePMNqIPd1745305877.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with swelling in the floor of the mouth. Upon examination, the swelling appears as shown in the image. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cystic hygroma", "correct": false}, {"label": "B", "text": "Ranula", "correct": true}, {"label": "C", "text": "Dermoid", "correct": false}, {"label": "D", "text": "Branchial cyst", "correct": false}], "correct_answer": "B. Ranula", "question_images": ["https://image.prepladder.com/content/VAAGjNN4p8bTOm3rv5rq1745211746.png"], "explanation_images": ["https://image.prepladder.com/content/b99EqFDvNaiICpQKYyVK1745211810.png", "https://image.prepladder.com/content/KjMeWRjJBGaJ8WSHkG1J1745932584.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ranulas are a type of <strong>extravasation mucocele</strong> caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the main <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or obstructed <span class=\"customMeta\" data-dictid=\"4e0948603216927771801829c2c085\">acini</span> of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> gland. They appear as <strong>bluish swellings</strong> on the floor of the mouth and resemble the belly of a frog.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ph0t0happy\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ranula_human_09.jpg\" data-tags=\"\" height=\"409\" src=\"https://image.prepladder.com/content/b99EqFDvNaiICpQKYyVK1745211810.png\" width=\"555\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Commonly found in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> floor of the mouth.</li>\n<li>When it extends through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle, it presents as a <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> known as a<strong> \"plunging ranula.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Typically soft, fluctuant, and painless unless infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Confirmed through Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</li>\n<li>Ultrasound</li>\n<li>Aspiration of thick, sticky <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> differentiates it from a lymphangioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Removal of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is preferred.</li>\n<li>Incision, drainage, and marsupialisation have low success rates. Although marsupialisation is often adequate, it has a higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate compared to <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> excision.</li>\n<li>OK-432 injection</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/KjMeWRjJBGaJ8WSHkG1J1745932584.png\" width=\"4167\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female patient undergoes a routine thyroid examination, during which a palpable thyroid nodule is discovered. Fine-needle aspiration cytology confirms the presence of papillary thyroid cancer. All of the following statements are true regarding papillary thyroid cancer Except:", "options": [{"label": "A", "text": "It often presents with cervical lymph node metastases.", "correct": false}, {"label": "B", "text": "It is the most common type of thyroid cancer.", "correct": false}, {"label": "C", "text": "It arises from parafollicular C-cells", "correct": true}, {"label": "D", "text": "It is TSH dependent", "correct": false}], "correct_answer": "C. It arises from parafollicular C-cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It arises from parafollicular C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child presents with a swelling in the subhyoid region of the neck that moves with deglutition and protrusion of the tongue. What is the recommended treatment for this patient?", "options": [{"label": "A", "text": "Total thyroidectomy", "correct": false}, {"label": "B", "text": "Ramstedt's operation", "correct": false}, {"label": "C", "text": "Hemi-thyroidectomy", "correct": false}, {"label": "D", "text": "Sistrunk's operation", "correct": true}], "correct_answer": "D. Sistrunk's operation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Sistrunk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with a bluish translucent extravasation cystic sublingual swelling . The swelling is accompanied by visible veins over the swelling and is transilluminant . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Thyroglossal cyst", "correct": false}, {"label": "B", "text": "Dermoid cyst", "correct": false}, {"label": "C", "text": "Ranula", "correct": true}, {"label": "D", "text": "Sublingual tumour", "correct": false}], "correct_answer": "C. Ranula", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - Ranu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Intubation of choice in a Maxillofacial trauma patient?", "options": [{"label": "A", "text": "Tracheostomy", "correct": true}, {"label": "B", "text": "Laryngeal mask airway", "correct": false}, {"label": "C", "text": "Orotracheal intubation", "correct": false}, {"label": "D", "text": "Mask ventilation", "correct": false}], "correct_answer": "A. Tracheostomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Trach\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly male presents with foul-smelling breath and dysphagia. A barium swallow X-ray is provided. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tracheoesophageal fistula", "correct": false}, {"label": "B", "text": "Achalasia cardia", "correct": false}, {"label": "C", "text": "Carcinoma esophagus", "correct": false}, {"label": "D", "text": "Zenker's diverticulum", "correct": true}], "correct_answer": "D. Zenker's diverticulum", "question_images": ["https://image.prepladder.com/content/TLcPAx7hS257R55GkM8h1741229238.png"], "explanation_images": ["https://image.prepladder.com/content/YbLEbaOHCsvswNCq5Iif1741229232.png", "https://image.prepladder.com/content/C5TiZq4Gt6uqfnKcRS1K1741229178.png", "https://image.prepladder.com/content/JMjhmIALDNK2rET640Zn1741856119.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Zenker's diverticulum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia is the most prominent feature appears when the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> gets filled with food and presses on the oesophagus.</li>\n<li>Gurgling sound is produced on swallowing.</li>\n<li>Regurgitation at night from undigested food causes <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia.</li>\n<li>Halitosis (Chronic bad breathing)</li>\n<li>Malnourished due to dysphagia.</li>\n<li>Associated <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">hiatus</span> hernia</li>\n<li>Rarely can a <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> develop in long-standing cases of pharyngeal pouches.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Barium swallow </strong>provides information regarding the size, location, and character of the mucosal lining.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/YbLEbaOHCsvswNCq5Iif1741229232.png\" width=\"265\"/></p>\n\t\t\t \n\n\t\t\t<p> </p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Endoscopy</strong> reveals <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and pooling of food in the diverticulum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> and <span class=\"customMeta\" data-dictid=\"07bb7766221692777185a58cad9233\">cricopharyngeal</span> myotomy</strong> was done through a <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> approach.</li>\n<li><strong>Dohlman’s procedure: </strong>The <span class=\"customMeta\" data-dictid=\"25c5ca7c4516927771942bb8637e83\">partition</span> wall between the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is exposed and divided by <span class=\"customMeta\" data-dictid=\"24bfc6e0cc16927771862d94b32d73\">diathermy</span> through a weerda scope.</li>\n<li><strong>Endoscopic laser treatment:</strong> <span class=\"customMeta\" data-dictid=\"25c5ca7c4516927771942bb8637e83\">Partition</span> wall between the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is exposed and divided by CO2 laser using an endoscope. This procedure is known to have fewer recurrences and faster improvement in symptoms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the level of lymph nodes indicated in the marked region of the neck in the given anatomical image.", "options": [{"label": "A", "text": "Level II", "correct": true}, {"label": "B", "text": "Level Ia", "correct": false}, {"label": "C", "text": "Level Ib", "correct": false}, {"label": "D", "text": "Level IV", "correct": false}], "correct_answer": "A. Level II", "question_images": ["https://image.prepladder.com/content/PFjXNKJtuJ4SSVXMTYA41741106358.png"], "explanation_images": ["https://image.prepladder.com/content/zJaV0kTQqZeUXQ8pMkvV1741106507.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submental &amp; submandibular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Divided into <span class=\"customMeta\" data-dictid=\"45d7632a0216927771898df908d43b\">Ia</span> (midline) &amp; Ib (lateral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jugulodigastric region (common in <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> CA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-jugular region</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> &amp; cricoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> &amp; clavicle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an indication for adjuvant radiotherapy in oral malignancy after resection and modified radical neck dissection (MRND)?", "options": [{"label": "A", "text": "Extranodal extension", "correct": true}, {"label": "B", "text": "Multiple lymph node metastasis", "correct": false}, {"label": "C", "text": "T3 tumor", "correct": false}, {"label": "D", "text": "Close margin", "correct": false}], "correct_answer": "A. Extranodal extension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the management of Squamous Cell Carcinoma (SCC) of the lip, which biopsy technique is most appropriate to obtain a representative sample of the tumor?", "options": [{"label": "A", "text": "Incisional Biopsy", "correct": true}, {"label": "B", "text": "Excisional Biopsy", "correct": false}, {"label": "C", "text": "Superficial Biopsy from the Border with Normal Tissue", "correct": false}, {"label": "D", "text": "Contraindicated", "correct": false}], "correct_answer": "A. Incisional Biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Incisional B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old smoker presents with ulcerative lesions on his lower lip for the past year. On examination, there is a palpable ipsilateral submental lymph node approximately 5x5 cm. A biopsy from the lesion is suggestive of squamous cell carcinoma. What is the next step in management?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Combined chemoradiotherapy", "correct": false}, {"label": "C", "text": "Resection with primary closure alone", "correct": false}, {"label": "D", "text": "Resection of primary lesion with lip reconstruction and MRND", "correct": true}], "correct_answer": "D. Resection of primary lesion with lip reconstruction and MRND", "question_images": ["https://image.prepladder.com/content/0pvioC3LSsemgvAtrGtY1747297168.png"], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>T Stage</strong></p>\n<ul>\n<li><strong>Tis: </strong>Carcinoma in situ</li>\n<li><strong>T1</strong>: Tumor ≤2 cm and ≤5 mm depth of invasion</li>\n<li><strong>T2</strong>: Tumor ≤2 cm and &gt;5 mm but ≤10 mm depth, <strong>OR</strong><br/>\n\t\t\t\tTumor &gt;2 cm but ≤4 cm and ≤10 mm depth</li>\n<li><strong>T3</strong>: Tumor &gt;4 cm <strong>OR</strong> any tumor &gt;10 mm depth of invasion</li>\n<li><strong>T4</strong>: Invasion of adjacent structures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N Stage:</strong></p>\n<ul>\n<li><strong>N0:</strong> No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</li>\n<li><strong>N1-N3</strong>: Based on number, size, and <span class=\"customMeta\" data-dictid=\"135a4fca481692777191e4ccc16a44\">laterality</span> of involved nodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M Stage:</strong></p>\n<ul>\n<li><strong>M0: </strong>No distant metastasis</li>\n<li><strong>M1: </strong>Distant metastasis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Early Stage (T1-T2N0)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with 1 cm margins</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for tumours&gt;2 cm or &gt;4 mm in depth</li>\n<li>Reconstruction: Primary closure, local flaps, or skin grafts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advanced Stage (T3-T4 or N+)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with ≥1 cm margins</li>\n<li>Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> (comprehensive or selective based on nodal status)</li>\n<li>Complex <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> (local/regional flaps, free tissue transfer)</li>\n<li>Adjuvant <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> or <span class=\"customMeta\" data-dictid=\"00cc356fdf1692777184c13ad34d10\">chemoradiotherapy</span> based on <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> findings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reconstruction Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wedge <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (for small lesions)</li>\n<li>Local flaps: <strong>Abbe-Estlander, Karapandzic, nasolabial</strong></li>\n<li>Regional flaps: Forehead, cervicofacial</li>\n<li>Free tissue transfer: Radial <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> free flap, <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> thigh flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of the Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elective neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for high-risk tumours (&gt;2 cm, &gt;4 mm depth)</li>\n<li>Therapeutic neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for clinically positive nodes</li>\n<li><strong>Levels typically addressed: I-III for N0 neck, I-V for N+ neck</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adjuvant: For positive margins, <span class=\"customMeta\" data-dictid=\"849a50eb4a1692777195de19bee5ed\">perineural</span> invasion, multiple positive nodes</li>\n<li>Definitive: For patients unfit for surgery or refusing surgery</li>\n<li>Brachytherapy: Can be considered for select early-stage lesions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Not routinely used in early-stage disease</li>\n<li>It may be combined with <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> in locally advanced cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follow-up and Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regular follow-up visits: Every 1-3 months for the first year, then gradually decreasing frequency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives at the emergency department following severe maxillofacial trauma sustained in a road traffic accident. The airway is compromised, and immediate intervention is required. What is the most appropriate immediate management?", "options": [{"label": "A", "text": "Tracheostomy", "correct": false}, {"label": "B", "text": "Orotracheal intubation", "correct": false}, {"label": "C", "text": "Cricothyroidotomy", "correct": true}, {"label": "D", "text": "Bag mask with jaw thrust", "correct": false}], "correct_answer": "C. Cricothyroidotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In modified radical neck dissection, which of the following structures is NOT preserved?", "options": [{"label": "A", "text": "Sternocleidomastoid muscle", "correct": false}, {"label": "B", "text": "Internal jugular vein", "correct": false}, {"label": "C", "text": "Spinal accessory nerve", "correct": false}, {"label": "D", "text": "Submandibular gland", "correct": true}], "correct_answer": "D. Submandibular gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MxxPwUmFPaFL22086j7p1747225854.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>LN removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Other structures removed/Preserved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Radical Neck Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV, and SCM removed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Modified Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (MRND) I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRND II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRND III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV, SCM preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extended Neck Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV, SCM removed + one/more LN groups +/- <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">Non</span> <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> structures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Selective Neck Dissections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>LN removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary site of cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Supra-omohyoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oral cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extended Supra-omohyoid</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and oropharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postero-Lateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">II - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Skin over the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> and upper neck</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">II - IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oropharynx, Hypopharynx, Larynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior/ Central</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">VI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Thyroid/ Midline structures</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is the most common parotid gland tumour?", "options": [{"label": "A", "text": "Pleomorphic adenoma", "correct": true}, {"label": "B", "text": "Warthin’s tumor", "correct": false}, {"label": "C", "text": "Adenoid cystic carcinoma", "correct": false}, {"label": "D", "text": "Mucoepidermoid carcinoma", "correct": false}], "correct_answer": "A. Pleomorphic adenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qzvQ1MJFC6hz2cmapq0s1747227174.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common<strong> benign</strong> tumour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Pleomorphic adenoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common <strong>benign</strong> tumour of infants and young children</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Hemangioma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common<strong> malignan</strong>t tumour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mucoepidermoid carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common <strong>malignant</strong> tumour in children and young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mucoepidermoid carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common<strong> malignant</strong> tumour of Minor salivary glands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> carcinoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a young patient under 5 years of age presenting with a painless, soft, fluctuating mass on the lateral side of the neck?", "options": [{"label": "A", "text": "Thyroglossal cyst", "correct": false}, {"label": "B", "text": "Cystic hygroma", "correct": true}, {"label": "C", "text": "Cervical lymphadenopathy", "correct": false}, {"label": "D", "text": "Ranula", "correct": false}], "correct_answer": "B. Cystic hygroma", "question_images": ["https://image.prepladder.com/content/xxOG5jX5cliIDVJGhEOw1747227568.png"], "explanation_images": ["https://image.prepladder.com/content/dwszgAuTBhS8hfs3hF2r1747227596.png", "https://image.prepladder.com/content/XMGup4Y1rFOCnaaO4QIF1747227601.png", "https://image.prepladder.com/content/FBGkLBb1u9C3JmkfHxiw1747227606.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the condition depicted in the given image, and what is the next investigation required for management?", "options": [{"label": "A", "text": "Erythroplakia and biopsy", "correct": true}, {"label": "B", "text": "Erythroplakia and observation", "correct": false}, {"label": "C", "text": "Leukoplakia and biopsy", "correct": false}, {"label": "D", "text": "Leukoplakia and observation", "correct": false}], "correct_answer": "A. Erythroplakia and biopsy", "question_images": ["https://image.prepladder.com/content/PO9xAHqQ0XLjM6nV2Hf71747285618.png"], "explanation_images": ["https://image.prepladder.com/content/CEDyMtd3NpRlNLj6d90t1747285666.png", "https://image.prepladder.com/content/ubRqJD9nC8mY5UXMZZ2u1747285672.png", "https://image.prepladder.com/content/px9qk3dgD0i1jMcz7lEG1747285685.png"], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Leukoplakia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Oral <span class=\"customMeta\" data-dictid=\"39ca145a0f1692777183a33d06e96d\">candidiasis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Premalignant lesion</li>\n<li>Causes: Pan masala chewing, Tobacco chewing, Betel quid</li>\n<li>Can be seen in adults above 40 years.</li>\n<li>White patch or plaque</li>\n<li>Surgical excision, CO<sub>2</sub> laser, and medications can be used to treat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Premalignant lesion</li>\n<li>Caused by Candida albicans</li>\n<li>Seen in immunosuppressed</li>\n<li>White curdy lesions</li>\n<li>Treated by <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals, surgery, or lasers.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following features seen due to compression of the following structures in the case of thyroid swelling: Structure Features 1. Trachea a. Hoarseness 2. Esophagus b. Horner syndrome 3. Sympathetic chain c. Dyspnea 4. Recurrent laryngeal nerve d. Dysphagia", "options": [{"label": "A", "text": "1-c, 2-d, 3-b, 4-a", "correct": true}, {"label": "B", "text": "1-d, 2-c, 3-a, 4-b", "correct": false}, {"label": "C", "text": "1-a, 2-d, 3-b, 4-c", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-d, 4-b", "correct": false}], "correct_answer": "A. 1-c, 2-d, 3-b, 4-a", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:361px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Compressed Feature</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Trachea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Dyspnea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Dysphagia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Sympathetic chain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Horner syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Recurrent laryngeal nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Hoarseness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "ABCD 2 scoring includes all the following parameters except?", "options": [{"label": "A", "text": "Age", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "History of stroke", "correct": true}, {"label": "D", "text": "Diabetes Mellitus", "correct": false}], "correct_answer": "C. History of stroke", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - History of stroke </p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Age</strong></td>\n<td><strong>Blood pressure</strong></td>\n<td><strong>Clinical features</strong></td>\n<td><strong>Duration of TIA</strong></td>\n<td><strong>DM</strong></td>\n</tr>\n<tr>\n<td><strong>No point</strong></td>\n<td>&lt;60 years</td>\n<td>&lt;140/90 mmHg</td>\n<td>No speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> and no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>&lt;10 minutes</td>\n<td>Absent</td>\n</tr>\n<tr>\n<td><strong>1 point</strong></td>\n<td>≥60 years</td>\n<td>≥140/90 mmHg</td>\n<td>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> present but no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>10-59 minutes</td>\n<td>Present</td>\n</tr>\n<tr>\n<td><strong>2 point</strong></td>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">-</td>\n<td>Unilateral weakness</td>\n<td>≥60 minutes</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Age</strong></td>\n<td><strong>Blood pressure</strong></td>\n<td><strong>Clinical features</strong></td>\n<td><strong>Duration of TIA</strong></td>\n<td><strong>DM</strong></td>\n</tr>\n<tr>\n<td><strong>No point</strong></td>\n<td>&lt;60 years</td>\n<td>&lt;140/90 mmHg</td>\n<td>No speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> and no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>&lt;10 minutes</td>\n<td>Absent</td>\n</tr>\n<tr>\n<td><strong>1 point</strong></td>\n<td>≥60 years</td>\n<td>≥140/90 mmHg</td>\n<td>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> present but no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>10-59 minutes</td>\n<td>Present</td>\n</tr>\n<tr>\n<td><strong>2 point</strong></td>\n<td>-</td>\n<td>-</td>\n<td>Unilateral weakness</td>\n<td>≥60 minutes</td>\n<td>-</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient had a RTA and was brought to the emergency room with bradycardia and a high BP. The GCS of this patient is &amp;lt; 8. What should be the immediate management in this patient?", "options": [{"label": "A", "text": "Urgent CT head", "correct": false}, {"label": "B", "text": "Intubate and IPPV", "correct": true}, {"label": "C", "text": "Thrombolysis", "correct": false}, {"label": "D", "text": "Normal saline infusion", "correct": false}], "correct_answer": "B. Intubate and IPPV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"ec62425aa9169277719050edbb4d55\"&gt;Intubate&lt;/span&gt; and IPPV (Intermittent &lt;span class=\"customMeta\" data-dictid=\"3121d7693a169277719696af2cead1\"&gt;Positive Pressure&lt;/span&gt; Ventilation)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which part of cranial fossa is injured in Raccoon eyes?", "options": [{"label": "A", "text": "Anterior cranial fossa", "correct": true}, {"label": "B", "text": "Middle cranial fossa", "correct": false}, {"label": "C", "text": "Posterior cranial fossa", "correct": false}, {"label": "D", "text": "Bone aponeurotic layer", "correct": false}], "correct_answer": "A. Anterior cranial fossa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\"&gt;cranial&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male chronic smoker came to OPD with cough, dyspnea, and difficulty swallowing . A palpable lump was present in the neck. Which of the following are smokers most likely to develop?", "options": [{"label": "A", "text": "Adenocarcinoma", "correct": false}, {"label": "B", "text": "Squamous cell carcinoma", "correct": true}, {"label": "C", "text": "Large cell carcinoma", "correct": false}, {"label": "D", "text": "Adenoid cystic carcinoma", "correct": false}], "correct_answer": "B. Squamous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Squamou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What procedure is typically employed for managing recurrent Ranula in a 55-year-old male who presented with a mass on the oral cavity floor, as depicted in the image, after undergoing a thorough history and examination by the emergency physician?", "options": [{"label": "A", "text": "Incision and drainage", "correct": false}, {"label": "B", "text": "Aspiration", "correct": false}, {"label": "C", "text": "Excision", "correct": true}, {"label": "D", "text": "Sclerosant injection", "correct": false}], "correct_answer": "C. Excision", "question_images": ["https://image.prepladder.com/content/MUcwGZLBkXoocynzhQUv1695540563.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Excision: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis?", "options": [{"label": "A", "text": "Lipoma", "correct": false}, {"label": "B", "text": "Encephalocele", "correct": true}, {"label": "C", "text": "Cystic hygroma", "correct": false}, {"label": "D", "text": "Lymphadenopathy", "correct": false}], "correct_answer": "B. Encephalocele", "question_images": ["https://image.prepladder.com/content/oMhYELuMX9Y8vV5V9Chz1691420278.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Enceph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Commonest site of branchial cyst :", "options": [{"label": "A", "text": "Lower 1/3 rd sternomastoid on anterior border", "correct": false}, {"label": "B", "text": "Lower 1/3 rd sternomastoid on posterior border", "correct": false}, {"label": "C", "text": "Upper 1/3 rd sternomastoid on anterior border", "correct": true}, {"label": "D", "text": "Upper 1/3 rd sternomastoid on posterior border", "correct": false}], "correct_answer": "C. Upper 1/3 rd sternomastoid on anterior border", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/65jQFoJzTg7RQ4TyxxKZ1714481632.png"], "explanation": "<p>Correct Option C - Upper 1/3&lt;sup&gt;rd&lt;/sup&gt; &lt;span class=\"customMeta\" data-dictid=\"d8cde9fb6a16927771990f620123da\"&gt;sternomastoid&lt;/span&gt; on &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;anterior&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common site of branchial cyst is___ .", "options": [{"label": "A", "text": "Junction of upper and middle third of the sternomastoid muscle", "correct": true}, {"label": "B", "text": "Junction of middle and lower third of the sternomastoid muscle", "correct": false}, {"label": "C", "text": "Middle of the sternomastoid muscle", "correct": false}, {"label": "D", "text": "Between the two heads of the sternomastoid muscle", "correct": false}], "correct_answer": "A. Junction of upper and middle third of the sternomastoid muscle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NN3PvhyDKPCBaCdf0iJW1714479467.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\"&gt;Junction&lt;/span&gt; of upper and middle third of the &lt;span class=\"customMeta\" data-dictid=\"d8cde9fb6a16927771990f620123da\"&gt;sternomastoid&lt;/span&gt; muscle:</p>\n<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Options B, C &amp; D are incorrect; refer to the explanation of the correct answer and learning objective.</li><li>➤ Options B, C &amp; D are incorrect; refer to the explanation of the correct answer and learning objective.</li><li>➤ Options B, C &amp; D</li></u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient complains of painless swelling over the face with difficulty in swallowing. The appearance of face is shown . The probable diagnosis is:", "options": [{"label": "A", "text": "Acute parotitis", "correct": false}, {"label": "B", "text": "Cancer of parotid gland", "correct": true}, {"label": "C", "text": "Angioedema of face", "correct": false}, {"label": "D", "text": "Acute sialadenitis", "correct": false}], "correct_answer": "B. Cancer of parotid gland", "question_images": ["https://image.prepladder.com/content/K5uIDIh7ZkPNahGHS56e1691492107.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Cancer of &lt;span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\"&gt;parotid&lt;/span&gt; g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old lady presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?", "options": [{"label": "A", "text": "Brachial cyst", "correct": false}, {"label": "B", "text": "Secondaries", "correct": false}, {"label": "C", "text": "TB", "correct": true}, {"label": "D", "text": "Lymphoma", "correct": false}], "correct_answer": "C. TB", "question_images": ["https://image.prepladder.com/content/OZDUuJJCq8WVOCuwGneW1716465197.png"], "explanation_images": [], "explanation": "<p>Correct Option C - TB\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 48 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45 y/o woman undergoes a superficial parotidectomy for a pleomorphic adenoma. Which of the following is a known complication associated with this condition or its treatment?", "options": [{"label": "A", "text": "Permanent facial nerve paralysis is common after parotidectomy.", "correct": false}, {"label": "B", "text": "Pleomorphic adenomas rarely recur after surgical excision.", "correct": false}, {"label": "C", "text": "Radiotherapy for pleomorphic adenoma is risk-free and only used as a primary treatment.", "correct": false}, {"label": "D", "text": "Frey’s syndrome is characterized by sweating and flushing in the preauricular area during meals.", "correct": true}], "correct_answer": "D. Frey’s syndrome is characterized by sweating and flushing in the preauricular area during meals.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2WCxeme3IR9Dr09YiyF71748240000.mp3", "video": ""}, {"text": "A 28-y/o male presents with a painless, soft swelling in the submandibular region that has been gradually enlarging over the past 2 months. On examination, the swelling is dumbbell-shaped, fluctuant, and bidigitally palpable. The overlying mucosa appears thick with a bluish hue. Fine needle aspiration yields a viscous, \"egg white-like\" fluid with high amylase content, confirming the diagnosis. What is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "Incision and drainage of the cyst", "correct": false}, {"label": "B", "text": "Marsupialization (unroofing) of the ranula", "correct": false}, {"label": "C", "text": "Surgical excision of the ranula and involved sublingual gland", "correct": true}, {"label": "D", "text": "Observation and follow-up", "correct": false}], "correct_answer": "C. Surgical excision of the ranula and involved sublingual gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/q0udCgIcdBdSDpTUXkXf1739277876.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plunging Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>When a <span class=\"customMeta\" data-dictid=\"b1093fbf8516927771974c3acef959\">ranula</span> extends into the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> region through the deeper part of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> margin of the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle it is called a plunging ranula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Painless, soft, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> dumbbell-shaped <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> region or <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> area. It is bidigitally palpable.</li>\n<li>May have a bluish hue and thick overlying mucosa.</li>\n<li>Often presents with <strong>both oral and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> components.</strong></li>\n<li>Typically occurs in the third decade of life.</li>\n</ul>\n<br/>\n<img alt=\"\" data-author=\"Moraes, Paulo &amp; Teixeira, Rubens &amp; Thomaz, Luiz &amp; Junqueira, José &amp; Oliveira, Luciana.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Extraoral-view-of-plunging-ranula-of-a-8-year-6-month-old-male-patient-The-mucus_fig1_289569857\" data-tags=\"\" height=\"253\" src=\"https://image.prepladder.com/content/q0udCgIcdBdSDpTUXkXf1739277876.png\" width=\"310\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Based on history, clinical features, and imaging.</li>\n<li>Fine needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> yields a viscous,<strong> \"egg white-like\" fluid with high <span class=\"customMeta\" data-dictid=\"ee24d3aa0016927771810af81a9cf3\">amylase</span> content.</strong></li>\n<li>Ultrasonography or CT shows a well-circumscribed <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> mass extending through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"b1093fbf8516927771974c3acef959\">ranula</span> and involved <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment.</li>\n<li>Recurrence is possible if the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is not completely removed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eKAHCDzhZTohCXuwoVbD1748242849.mp3", "video": ""}, {"text": "A 16 y/o female has a painless, soft, fluctuant swelling in the anterior floor of her mouth that has increased in size over a few weeks. There is no history of trauma or infection. What is the most appropriate next step in confirming the diagnosis?", "options": [{"label": "A", "text": "Magnetic Resonance Imaging", "correct": true}, {"label": "B", "text": "Computed Tomography", "correct": false}, {"label": "C", "text": "Incisional biopsy", "correct": false}, {"label": "D", "text": "Aspiration of the lesion", "correct": false}], "correct_answer": "A. Magnetic Resonance Imaging", "question_images": ["https://image.prepladder.com/content/mqBeTEb7H1eXvtjeMRnb1739276719.png"], "explanation_images": ["https://image.prepladder.com/content/zPnaSmn0DlvCgC7tKMsk1739277619.png", "https://image.prepladder.com/content/9SWnU2Z9zmurk97nY8KG1739276919.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ranulas are a type of <strong>extravasation mucocele</strong>, caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the main <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or obstructed <span class=\"customMeta\" data-dictid=\"4e0948603216927771801829c2c085\">acini</span> of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> gland. They appear as <strong>bluish swellings</strong> on the floor of the mouth and resemble the belly of a frog.</p>\n<p><img alt=\"\" data-author=\"Ph0t0happy\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ranula_human_09.jpg\" data-tags=\"\" height=\"394\" src=\"https://image.prepladder.com/content/zPnaSmn0DlvCgC7tKMsk1739277619.png\" width=\"377\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Commonly found in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> floor of the mouth.</li>\n<li>When it extends through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle, it presents as a <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> known as a<strong> \"plunging ranula.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Typically soft, fluctuant, and painless unless infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Confirmed through Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</li>\n<li>Ultrasound</li>\n<li>Aspiration of thick sticky <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> differentiates it from a lymphangioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Removal of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is preferred.</li>\n<li>Incision, drainage, and <span class=\"customMeta\" data-dictid=\"f577d7382a16927771915daa0fd8ea\">marsupialization</span> have low success rates. Although <span class=\"customMeta\" data-dictid=\"f577d7382a16927771915daa0fd8ea\">marsupialization</span> is often adequate, it has a higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate compared to <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> excision.</li>\n<li>OK-432 injection</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</li>\n</ul>\n<p><img alt=\"\" data-author=\"na\" data-hash=\"\" data-license=\"na\" data-source=\"na\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/9SWnU2Z9zmurk97nY8KG1739276919.png\" width=\"470\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Rlkt8R2zhsFsKcIM5Wb11748242699.mp3", "video": ""}, {"text": "A 52 y/o male has recurrent pain and swelling in the left lower jaw, worsening over several months. On examination, there is a significant swelling of the right submandibular gland, but no palpable stone. A CT scan shows an 8 mm stone deep within the submandibular gland, inaccessible by sialendoscopy. What is the best next step in management?", "options": [{"label": "A", "text": "Endoscopic removal of the stone", "correct": false}, {"label": "B", "text": "Ductal slitting for stone extraction", "correct": false}, {"label": "C", "text": "External shock wave lithotripsy (ESWL)", "correct": true}, {"label": "D", "text": "Gland excision", "correct": false}], "correct_answer": "C. External shock wave lithotripsy (ESWL)", "question_images": ["https://image.prepladder.com/content/SLlP5D27oxQ18RtoJB9A1739276255.png"], "explanation_images": ["https://image.prepladder.com/content/mZvhszElAp7UnYSbLAEf1739276488.png", "https://image.prepladder.com/content/YqAyuyyNDfUeU0v1fZnh1739276539.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sialolithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Formation of salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> stones within the <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> ducts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Commonly Affected Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>30 to 60 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Commonly Affected Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> (85%), </strong>due to its <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> course and the mucinous, <span class=\"customMeta\" data-dictid=\"bf33f8775d169277720289f4026e23\">viscous</span> <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> it produces, leads to stagnation and stone formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Duct abnormalities</li>\n<li>Inflammation</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> content in saliva</li>\n<li>Chronic dehydration</li>\n<li>Medications causing decreased salivary flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cyclical <span class=\"customMeta\" data-dictid=\"5e98c7ac6916927771967b424f152e\">postprandial</span> swelling, dryness, asymmetrical <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> enlargement, <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> stone, possible <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation.</p>\n<img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Submandular2.JPG\" data-tags=\"\" height=\"344\" src=\"https://image.prepladder.com/content/mZvhszElAp7UnYSbLAEf1739276488.png\" width=\"500\"/>\n<p><strong>Submandibular Swelling</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnostic Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Conventional Radiographs</strong>: Initial <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test, but may miss small stones.</li>\n<li><strong>CT Scanning, USG, Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> Sialogram</strong>: More sensitive, especially for small stones.</li>\n<li><strong>Sialography</strong>: Gold standard; involves <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> for diagnosis and potential <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> use.</li>\n<li><strong>Sialendoscopy</strong>: Direct <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> and removal of stones, safer than open surgery.</li>\n</ul>\n<img alt=\"\" data-author=\"Jmarchn\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:CT_Wharton%27s_duct_sialolithiasis._Case_1._139._indicated.png\" data-tags=\"\" height=\"762\" src=\"https://image.prepladder.com/content/YqAyuyyNDfUeU0v1fZnh1739276539.png\" width=\"500\"/>\n<p><strong>CT- Wharton’s <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> Sialolithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Small <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> Stones (&lt;5 mm)</strong>: <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> removal <strong>(Option A ruled out)</strong></li>\n<li><strong>Large <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> Stones (&gt;5 mm)</strong>: <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> slitting <strong>(Option B ruled out)</strong></li>\n<li><strong>Impacted Stones</strong>: Transoral route</li>\n<li><strong>Intraparenchymal Stones (5–7 mm)</strong>: <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> extraction</li>\n<li><strong>Large Stones (7-10 mm)</strong>: May require transoral slitting or external shock wave <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> (ESWL)</li>\n<li><strong>Hilar Stones</strong>: <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> removal</li>\n<li><strong>Gland Removal</strong>: Last resort if other treatments fail <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9FxjeX1moXEYA7wpqZVm1748242495.mp3", "video": ""}, {"text": "A 45 y/o woman is undergoing surgery for the removal of a submandibular gland mass. Postoperatively, she complains of numbness and a burning sensation of her tongue. Which nerve is most likely to have been injured during the procedure?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Lingual Nerve", "correct": true}, {"label": "C", "text": "Hypoglossal Nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal Nerve", "correct": false}], "correct_answer": "B. Lingual Nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5dqliVqgwVucfxRFGIXH1739276047.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RwOTqfAz7Twd2klvqRzW1748242209.mp3", "video": ""}, {"text": "A 60 y/o man with a diagnosis of adenoid cystic carcinoma has undergone surgical resection of a tumour located in the palate. Postoperative imaging reveals no residual tumour but shows the involvement of regional lymph nodes. What is the most appropriate additional treatment for this patient?", "options": [{"label": "A", "text": "Additional surgical resection", "correct": false}, {"label": "B", "text": "External beam radiotherapy", "correct": true}, {"label": "C", "text": "Preoperative chemotherapy", "correct": false}, {"label": "D", "text": "Observation and regular follow-up", "correct": false}], "correct_answer": "B. External beam radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z7Upr9HPtUWKazGd9Iaw1748242079.mp3", "video": ""}, {"text": "A 60 y/o man presents with a slow-growing, painless mass in the submandibular region. O/E, the mass is firm and non-tender and biopsy reveals a tumor with a combination of tubular and solid histological patterns. Imaging shows perineural invasion extending towards the base of the skull. Which histopathological type in this carcinoma is associated with the worst prognosis?", "options": [{"label": "A", "text": "Cribriform", "correct": false}, {"label": "B", "text": "Tubular", "correct": false}, {"label": "C", "text": "Solid", "correct": true}, {"label": "D", "text": "Papillary", "correct": false}], "correct_answer": "C. Solid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pvTLmF7c3gscD6hu3Ho11748240875.mp3", "video": ""}, {"text": "Which immunohistochemical marker helps to distinguish acinic cell carcinoma from secretory carcinoma?", "options": [{"label": "A", "text": "p53", "correct": false}, {"label": "B", "text": "Mammaglobin", "correct": true}, {"label": "C", "text": "S100", "correct": false}, {"label": "D", "text": "Ki-67", "correct": false}], "correct_answer": "B. Mammaglobin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VljHs7MA4sTMeCz9grwk1748240663.mp3", "video": ""}, {"text": "A 45 y/o female has a firm, enlarging swelling below her left ear for 6 months. O/E, the swelling is hard and nodular, with no signs of facial nerve involvement. FNAC shows malignant cells, and imaging reveals a tumour in both lobes of the parotid gland with no distant metastases. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pleomorphic adenoma", "correct": false}, {"label": "B", "text": "Mucoepidermoid carcinoma", "correct": true}, {"label": "C", "text": "Adenoid cystic carcinoma", "correct": false}, {"label": "D", "text": "Warthin’s tumor", "correct": false}], "correct_answer": "B. Mucoepidermoid carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NLVDoHJLulwb0pUhVh4g1748240544.mp3", "video": ""}, {"text": "Which of the following statements about Warthin's tumour and its diagnostic features is correct?", "options": [{"label": "A", "text": "It is best identified on imaging by its hypoechoic appearance and confirmed with FNAC.", "correct": false}, {"label": "B", "text": "A Tc99 pertechnetate scan showing a \"hotspot\" is indicative of Warthin's tumour.", "correct": true}, {"label": "C", "text": "HPE shows mucin-secreting cells", "correct": false}, {"label": "D", "text": "Warthin's tumour generally exhibits low uptake on Tc99 pertechnetate scans", "correct": false}], "correct_answer": "B. A Tc99 pertechnetate scan showing a \"hotspot\" is indicative of Warthin's tumour.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tSmkqGUCEV3aC3w71zcu1748240298.mp3", "video": ""}, {"text": "Which of the following salivary glands secretes saliva through Stensen’s duct?", "options": [{"label": "A", "text": "Parotid gland", "correct": true}, {"label": "B", "text": "Submandibular gland", "correct": false}, {"label": "C", "text": "Sublingual gland", "correct": false}, {"label": "D", "text": "Minor salivary glands", "correct": false}], "correct_answer": "A. Parotid gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HeWmMQJRt94zhbcU8unk1739266325.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duct</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parotid gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stensen’s Duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wharton’s Duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sublingual gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ducts of Rivinus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor salivary glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numerous small ducts</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/V4XM756idcJVHcMLZIk51748180399.mp3", "video": ""}, {"text": "A 35 y/o female has a slowly enlarging, painless, well-defined mass in the left parotid gland, present for two years. O/E there is no facial nerve involvement. Ultrasound shows a well-lobulated, hypoechoic lesion, and FNAC suggests a benign neoplasm. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Observation and follow-up", "correct": false}, {"label": "B", "text": "Radiotherapy", "correct": false}, {"label": "C", "text": "Surgical excision with a margin of normal tissue", "correct": true}, {"label": "D", "text": "Enucleation of the tumour", "correct": false}], "correct_answer": "C. Surgical excision with a margin of normal tissue", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BlCQNEiajpYAJjF3sYtj1748239807.mp3", "video": ""}, {"text": "A 50 y/o female with swelling and pus discharge from the left cheek for two weeks, worsening with eating, recently had a superficial parotidectomy. Examination reveals a small external opening at the parotid region with saliva-like discharge. What is the best initial management?", "options": [{"label": "A", "text": "Antibiotics and observation", "correct": false}, {"label": "B", "text": "Sialography to evaluate the fistula", "correct": false}, {"label": "C", "text": "Surgical exploration and repair", "correct": false}, {"label": "D", "text": "Anticholinergic therapy with hyoscine bromide", "correct": true}], "correct_answer": "D. Anticholinergic therapy with hyoscine bromide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AXfdS4Psg46CvYKONeew1748239598.mp3", "video": ""}, {"text": "A 60 y/o male undergoes a parotidectomy for a benign tumour located in the superficial lobe of the parotid gland. On the second postoperative day, he notices sweating and flushing in the area just in front of his ear when he eats. The patient also reports mild numbness of the earlobe. Which of the following nerves is most commonly affected?", "options": [{"label": "A", "text": "Facial nerve", "correct": false}, {"label": "B", "text": "Auriculotemporal nerve", "correct": true}, {"label": "C", "text": "Great auricular nerve", "correct": false}, {"label": "D", "text": "Hypoglossal nerve", "correct": false}], "correct_answer": "B. Auriculotemporal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Temporary <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Palsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mostly the lower branches of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve - the marginal mandibular nerve.</li>\n<li>Most patients recover over time.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Infection </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rare, as <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">parotidectomy</span> is a clean procedure.</li>\n<li>Aseptic precautions and timely drain removal reduce the risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hematoma Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncommon.</li>\n<li>Careful <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">hemostasis</span> can prevent it.</li>\n<li>Larger hematomas may indicate a <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorder and require management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sialocele Formation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs if the main ductal system is exposed.</li>\n<li>Preventable with <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> dissection.</li>\n<li>Treatment: Anticholinergics, aspiration, and pressure dressings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Retromandibular area hollowing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can occur post-surgery</li>\n<li>Reduced by placing <span class=\"customMeta\" data-dictid=\"0a266da66816927771824d58668832\">autologous</span> fat grafts during the surgery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Frey’s Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also known as gustatory sweating;</li>\n<li>Caused by the<strong> cross-innervation</strong> of sweat glands by regenerating nerve fibres of the <span class=\"customMeta\" data-dictid=\"c2c10e783c1692777182a1d84457f9\">auriculotemporal</span> nerve. <strong>(Option B)</strong></li>\n<li><u>For mild cases</u>: Give antiperspirants;</li>\n<li><u>Severe cases</u>: <span class=\"customMeta\" data-dictid=\"3cb8b8422c16927771836b57b4c79e\">Botulinum toxin</span> injections or <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> neurectomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Permanent <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Nerve Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>D/t <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve during the surgery. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Facial Numbness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Permanent <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> of the earlobe,</li>\n<li>D/t <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> of the great <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve during the surgery. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XOMbgrYAV2zoZV8ug9Fj1748239449.mp3", "video": ""}, {"text": "A 45 y/o patient presents with a parotid gland tumour located deep to the facial nerve. The tumour has been identified as malignant and has extended beyond the parotid gland. Given these findings, which surgical approach is most appropriate for this patient?", "options": [{"label": "A", "text": "Radical parotidectomy", "correct": true}, {"label": "B", "text": "Total conservative parotidectomy", "correct": false}, {"label": "C", "text": "Superficial parotidectomy", "correct": false}, {"label": "D", "text": "Adequate parotidectomy", "correct": false}], "correct_answer": "A. Radical parotidectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Extracapsular <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tumor removed.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve dissection.</li>\n<li>↓ Chances of temporary <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Adequate <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">Parotidectomy</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tumor removal along with some healthy tissue.</li>\n<li>Aimed to preserve the gland.</li>\n<li>Challenging if the tumour is near the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Superficial <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">Parotidectomy</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Performed when the tumour is located <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">Parotidectomy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicated when the tumour is deep to the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Total Conservative <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">Parotidectomy</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves removing both <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> and deep lobes while preserving the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerves. Used for tumours crossing the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve plane.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Radical <span class=\"customMeta\" data-dictid=\"4b79a10aff16927771941f5a4084ea\">Parotidectomy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete removal of the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland, including any involved <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve branches, for <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumours extending beyond the gland.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/91jNHOjgLT2WC5tiJC651748237795.mp3", "video": ""}, {"text": "A 62 y/o woman presents with a recurrent adenoid cystic carcinoma of the submandibular gland. The tumour has been surgically resected twice before, and each time, the pathology report showed perineural invasion. What is the most appropriate next step in managing her condition?", "options": [{"label": "A", "text": "Repeat surgical excision", "correct": false}, {"label": "B", "text": "Radiation therapy", "correct": true}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Targeted therapy", "correct": false}], "correct_answer": "B. Radiation therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/60UVLmkzxhR6urWZKKKM1748180898.mp3", "video": ""}, {"text": "A 45 y/o woman presents with a progressively enlarging mass in her right parotid gland. The mass is non-tender and has been present for 6 months. An ultrasound revealed a well-defined hypoechoic lesion with no evidence of calcification or increased vascularity. Which of the following is the most appropriate next step for this patient?", "options": [{"label": "A", "text": "Sialography", "correct": false}, {"label": "B", "text": "Positron Emission Tomography (PET-CT)", "correct": false}, {"label": "C", "text": "Core Needle Biopsy", "correct": false}, {"label": "D", "text": "Fine-needle aspiration Cytology (FNAC)", "correct": true}], "correct_answer": "D. Fine-needle aspiration Cytology (FNAC)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/e06PMxBdemPaqcrlKF0y1748180788.mp3", "video": ""}, {"text": "Which is the most common salivary gland tumour found in infants and young children?", "options": [{"label": "A", "text": "Pleomorphic adenoma", "correct": false}, {"label": "B", "text": "Mucoepidermoid carcinoma", "correct": false}, {"label": "C", "text": "Hemangioma", "correct": true}, {"label": "D", "text": "Adenoid cystic carcinoma", "correct": false}], "correct_answer": "C. Hemangioma", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common<strong> benign</strong> tumour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleomorphic adenoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common <strong>benign</strong> tumour of infants and young children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemangioma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common<strong> malignan</strong>t tumour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucoepidermoid carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common <strong>malignant</strong> tumour in children and young adults</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucoepidermoid carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common<strong> malignant</strong> tumour of Minor salivary glands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> carcinoma</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zio5JCeuk6FV1HVIb8wC1748180645.mp3", "video": ""}, {"text": "A 50 y/o male presents with a swelling in his parotid gland, and a biopsy reveals a Warthin's tumour. Which of the following is most likely a contributing risk factor for this patient's condition?", "options": [{"label": "A", "text": "Radiation exposure in childhood", "correct": false}, {"label": "B", "text": "Chronic inflammation of the salivary glands", "correct": false}, {"label": "C", "text": "Smoking history", "correct": true}, {"label": "D", "text": "Immunocompromised state", "correct": false}], "correct_answer": "C. Smoking history", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HYggYjbNewaGOhSUAlsS1748180533.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 29 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 50 year old woman presents with complaints of persistent fatigue, itching, and mild right upper quadrant abdominal pain. On examination, she has jaundice and hepatomegaly. Laboratory tests reveal elevated alkaline phosphatase and positive anti-mitochondrial antibodies. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary biliary cirrhosis", "correct": true}, {"label": "B", "text": "Primary sclerosing cholangitis", "correct": false}, {"label": "C", "text": "Autoimmune hepatitis", "correct": false}, {"label": "D", "text": "Drug-induced liver disease", "correct": false}], "correct_answer": "A. Primary biliary cirrhosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8c5zYxZdCm0YqlsPuVym1748849321.mp3", "video": ""}, {"text": "A 70 year old male presents with painless obstructive jaundice, significant weight loss, and a palpable, non-tender mass in the right hypochondrium. Imaging reveals a mass at the liver hilum with no evidence of distant metastasis. What is the correct management of this patient?", "options": [{"label": "A", "text": "Stenting through PTC or ERCP", "correct": false}, {"label": "B", "text": "Portal region clearance with hemihepatectomy", "correct": false}, {"label": "C", "text": "Extensive bile duct resection, nodal clearance, caudate lobe removal, and cholecystectomy", "correct": true}, {"label": "D", "text": "Chemotherapy with 5-FU and cisplatin", "correct": false}], "correct_answer": "C. Extensive bile duct resection, nodal clearance, caudate lobe removal, and cholecystectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ultrasound abdomen</li>\n<li>CT scan</li>\n<li>MR scan (best investigation)\n\t\t\t\t<ul>\n<li>MRCP to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the ducts</li>\n<li>MRI to assess <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>MR <span class=\"customMeta\" data-dictid=\"fa1da4abca1692777181b5898561f7\">angiogram</span> to evaluate vascularity</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic and Other procedures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ERCP</li>\n<li>Choledochoscope</li>\n<li>PTC (Percutaneous Transhepatic Cholangiography)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laboratory Tests</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver function tests</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical options (if operable)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Portal region <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> with hemi-hepatectomy (for <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> type)</li>\n<li>Hemi-hepatectomy or extensive <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> resection, nodal clearance, <span class=\"customMeta\" data-dictid=\"1d14ed8c1216927771832ccea0c79f\">caudate</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> removal, <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> (for <span class=\"customMeta\" data-dictid=\"b78b1bdf6c1692777195170be3d18f\">perihilar</span> type)</li>\n<li>Whipple's <span class=\"customMeta\" data-dictid=\"2e8a2c4bdb1692777194217b471307\">pancreaticoduodenectomy</span> (for <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> tumors)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palliative options (if operable)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stenting to relieve <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> (through PTC or ERCP or intraoperatively)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>5-Fluorouracil (5-FU)</li>\n<li>Gemcitabine</li>\n<li>Cisplatin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>External Beam Radiotherapy (ERBT) in combination with chemotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LaeLsixXpvnvms1QhEX11748852103.mp3", "video": ""}, {"text": "A 55 year old woman undergoes a cholecystectomy, after which she develops jaundice and abdominal pain. Imaging reveals a bile duct stricture at the confluence of the right and left hepatic ducts, but the ducts themselves are intact. According to the Bismuth classification, what type of stricture does she have?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": true}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "C. Type III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZKCFUNb9Pya2NaEjfXvw1738762466.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:534px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bismuth <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> for <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> strictures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> &gt;2cm</li>\n<li>Stricture is Low <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> &lt;2cm</li>\n<li>Stricture is mid<strong> </strong><strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hilar <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> with intact confluence</li>\n<li>Stricture is high</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hilar <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> with destroyed <span class=\"customMeta\" data-dictid=\"88204184f916927771840c8ffcea6b\">confluence</span> <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stricture involving <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> with or without <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> of common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> duct</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5bf5aVhEM53JOMfhj3Uz1748849633.mp3", "video": ""}, {"text": "A 45-year-old woman presents with worsening abdominal pain, jaundice, and fever. Ultrasound shows a choledochal cyst and bile duct obstruction. What imaging study is most appropriate for the next step in management?", "options": [{"label": "A", "text": "CT Scan", "correct": false}, {"label": "B", "text": "Magnetic Resonance Cholangiopancreatography", "correct": false}, {"label": "C", "text": "Endoscopic Retrograde Cholangiopancreatography", "correct": true}, {"label": "D", "text": "Percutaneous Transhepatic Cholangiography", "correct": false}], "correct_answer": "C. Endoscopic Retrograde Cholangiopancreatography", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p3PwfCKFl9i26uLLYQ7U1738757267.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INVESTIGATIONS - <span class=\"customMeta\" data-dictid=\"dab15cbc3a1692777184db8eae94c4\">CHOLEDOCHAL</span> CYST</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The first <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test that is performed.</li>\n<li>Confirms the presence of the cyst.</li>\n<li>Reveals <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> details, including <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> and pancreatic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> relationship.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"81439c0f9716927771841fe69eb19e\">Cholangiopancreatography</span> (MRCP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-invasive <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> technique. <strong>(Option B ruled out)</strong></li>\n<li>Provides detailed images of the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> and <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system.</li>\n<li>Highly sensitive (&gt;90%) and specific (&gt;99%) for identifying common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> stones.</li>\n<li>Visualizes <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and the extent of dilatation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">Retrograde</span> <span class=\"customMeta\" data-dictid=\"81439c0f9716927771841fe69eb19e\">Cholangiopancreatography</span> (ERCP):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive procedure with <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> and contrast material.</li>\n<li>Diagnostic and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> capabilities (tissue sampling, decompression, treatment of choledocholithiasis).</li>\n<li>Effective but has a <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rate of up to 10%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Percutaneous Transhepatic <span class=\"customMeta\" data-dictid=\"2818bdbbec1692777184c5a415093a\">Cholangiography</span> (PTC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive procedure with a needle directly into the liver.</li>\n<li>Useful for <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> disease or when <span class=\"customMeta\" data-dictid=\"b2276d3d4c16927771872281723792\">ERCP</span> is not feasible. <strong>(Option D ruled out)</strong></li>\n<li>Helps delineate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and enables <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> and <span class=\"customMeta\" data-dictid=\"cb33defbb316927771991b2ef81ec3\">stent</span> placement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT SCAN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly to see the <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatobiliary <span class=\"customMeta\" data-dictid=\"7f1cbc3c0c1692777193ca23ddc2b5\">nuclide</span> Scanning</li>\n<li>Liver Function Tests</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CQjPzGQUMmeFx1AfQkSo1748850964.mp3", "video": ""}, {"text": "A 25-year-old woman presents with persistent right upper quadrant pain for several days, fever, and jaundice. On examination, right upper quadrant tenderness is present. On USG, cystic dilation of the common bile duct is seen. Which of the following malignancies is not associated with this condition?", "options": [{"label": "A", "text": "Cholangiocarcinoma", "correct": false}, {"label": "B", "text": "Squamous Cell carcinoma", "correct": false}, {"label": "C", "text": "Pancreatic Carcinoma", "correct": false}, {"label": "D", "text": "Renal cell carcinoma", "correct": true}], "correct_answer": "D. Renal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jNqG4TIa4qjFvfefzQLZ1748850817.mp3", "video": ""}, {"text": "MRCP imaging studies done for a 35 year old woman who presented with a history of recurrent cholangitis, jaundice, and right upper quadrant pain reveal the following. Based on the Todani classification, what is the most appropriate surgical treatment for this patient?", "options": [{"label": "A", "text": "Liver transplantation", "correct": false}, {"label": "B", "text": "Transduodenal sphincteroplasty", "correct": false}, {"label": "C", "text": "Roux-en-Y hepaticojejunostomy", "correct": true}, {"label": "D", "text": "Partial hepatectomy", "correct": false}], "correct_answer": "C. Roux-en-Y hepaticojejunostomy", "question_images": ["https://image.prepladder.com/content/KYXKQ9MV4CxSKHIbeKqY1738756825.png"], "explanation_images": ["https://image.prepladder.com/content/5i7bhD0Ci7jV2wDa9OVm1738756897.png", "https://image.prepladder.com/content/WnpSMLZIBMoWrz52dVuX1738756947.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Todani <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> of Alonso- Lej classification</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (Most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ib</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fusiform <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diverticular <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilatation of <span class=\"customMeta\" data-dictid=\"977c284355169277719056fe0e0992\">intraduodenal</span> part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (choledochocele)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilatation of both <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> and <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple cysts involving <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type V</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple cysts involving <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> only (Caroli’s disease)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Complete excision, cholecystectomy, Roux-en-Y hepaticojejunostomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Complete excision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Transduodenal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or <span class=\"customMeta\" data-dictid=\"7eb266ea2d1692777199505deca5c6\">sphincteroplasty</span> <strong>(Option B ruled out)</strong>; <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> may suffice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type IVa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Tailored to anatomy: <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> cysts treated like Type I; partial <span class=\"customMeta\" data-dictid=\"bba73f86101692777188a1212603eb\">hepatectomy</span> and <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> involvement <strong> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type IVb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Managed like Type I</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Type V (Caroli disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Resection for <span class=\"customMeta\" data-dictid=\"7ba13837e7169277720134d37214a8\">unilobar</span> disease; liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> disease <strong> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Msyd3mBry87And6AuYSn1748850663.mp3", "video": ""}, {"text": "According to the Strasberg classification, what type of bile duct injury does this image show?", "options": [{"label": "A", "text": "Class A", "correct": true}, {"label": "B", "text": "Class B", "correct": false}, {"label": "C", "text": "Class C", "correct": false}, {"label": "D", "text": "Class D", "correct": false}], "correct_answer": "A. Class A", "question_images": ["https://image.prepladder.com/content/vm04br9ipWOt0ztqFDhb1738774297.png"], "explanation_images": ["https://image.prepladder.com/content/wp58xnJiZ3AGwx1V64J01739878595.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:268px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type A <strong>(M/C)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> leak or leak from sub-vesical <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> of Luschka</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type B</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ligation or <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type C</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transection without <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of the <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type D</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of the Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type E</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>E1 to E5 <span class=\"customMeta\" data-dictid=\"2940cc0ecd169277718375b839902c\">Bismuth</span> classification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NDKjS5WnET0FaKY3yQ1P1748852509.mp3", "video": ""}, {"text": "A 45-year-old male presents with severe colicky pain in the upper right quadrant, jaundice, and episodes of haematemesis and melaena. He had a history of blunt abdominal trauma a few weeks ago. Which is the investigation of choice for detecting the bleeding site in this patient?", "options": [{"label": "A", "text": "Liver Function Tests", "correct": false}, {"label": "B", "text": "Ultrasound of the abdomen", "correct": false}, {"label": "C", "text": "Selective arteriography", "correct": true}, {"label": "D", "text": "Upper GI endoscopy", "correct": false}], "correct_answer": "C. Selective arteriography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trauma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accidental <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma</li>\n<li>Iatrogenic trauma</li>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> procedures</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> diseases (10%)</li>\n<li>Hepatic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> (common cause)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant liver diseases (more common, 5%)</li>\n<li>Benign liver diseases</li>\n<li>Parasitic liver diseases (e.g., <span class=\"customMeta\" data-dictid=\"cc96ad6655169277718944f7ffe9ae\">hydatid</span> disease)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arterial hemobilia(common)</li>\n<li>Portal hypertension</li>\n<li>Gallstones (rare)</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"0edb7dd1401692777188c88f6dda48\">hemobilia</span> (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aEx9cxjcfnhP2Hq8pj0e1748852366.mp3", "video": ""}, {"text": "A 65 year old female presents with painless jaundice and a palpable, non-tender, globular mass in the right hypochondrium. Imaging suggests an obstructed biliary system. The patient has no history of gallstones. Based on Courvoisier's law, which of the following conditions is not an exception to the rule?", "options": [{"label": "A", "text": "Double impacted stone", "correct": false}, {"label": "B", "text": "A large stone in Hartmann's pouch", "correct": false}, {"label": "C", "text": "Empyema of the gallbladder with a CBD stone", "correct": false}, {"label": "D", "text": "Chronic cholecystitis with multiple gallstones", "correct": true}], "correct_answer": "D. Chronic cholecystitis with multiple gallstones", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ampullary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periampullary</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They originate in the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They originate in the pancreas, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, or intestines close to the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They have a better survival rate than <span class=\"customMeta\" data-dictid=\"9fab1cb2e416927771950a4f5dfcfd\">periampullary</span> cancers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poorer survival rate.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JZU3XMLrlhqKDSudzYr41748851906.mp3", "video": ""}, {"text": "A 58 year old female presents with painless obstructive jaundice, significant weight loss, and anorexia. Imaging reveals a tumour involving the confluence of the right hepatic duct and left hepatic duct, extending into both ducts. Based on the Bismuth-Corlette classification, which type of perihilar cholangiocarcinoma is most consistent with these findings?", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2", "correct": false}, {"label": "C", "text": "Type 3A", "correct": false}, {"label": "D", "text": "Type 4", "correct": true}], "correct_answer": "D. Type 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DXf2lqtMJnVm37LitQmk1738769297.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Below the <span class=\"customMeta\" data-dictid=\"88204184f916927771840c8ffcea6b\">confluence</span> of RHD and LHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reaching the <span class=\"customMeta\" data-dictid=\"88204184f916927771840c8ffcea6b\">confluence</span> of RHD and LHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3A</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Type 3B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involving <span class=\"customMeta\" data-dictid=\"d1dfa2a890169277718420f4be43db\">CHD</span> with RHD</p>\n\t\t\t \n\n\t\t\t<p>Involving <span class=\"customMeta\" data-dictid=\"d1dfa2a890169277718420f4be43db\">CHD</span> with LHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involving <span class=\"customMeta\" data-dictid=\"88204184f916927771840c8ffcea6b\">confluence</span> and both RHD and LHD or <span class=\"customMeta\" data-dictid=\"e0f2552ebe1692777193a7383110f5\">multicentric</span> tumor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3HA6AGREIjxaJg6oic5D1748851576.mp3", "video": ""}, {"text": "Which of the following is not a risk factor for cholangiocarcinoma?", "options": [{"label": "A", "text": "Primary sclerosing cholangitis", "correct": false}, {"label": "B", "text": "Hepatitis C", "correct": false}, {"label": "C", "text": "Clonorchis sinensis infestation", "correct": false}, {"label": "D", "text": "Alcohol consumption", "correct": true}], "correct_answer": "D. Alcohol consumption", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kIlI8A6dI4fPNvqVANv11738769054.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RcpCdHaCZJTQexcNZ05H1748851371.mp3", "video": ""}, {"text": "Which of the following is the classical triad of acute cholangitis?", "options": [{"label": "A", "text": "Pain, jaundice, fever", "correct": true}, {"label": "B", "text": "Pain, jaundice, shock", "correct": false}, {"label": "C", "text": "Fever, jaundice, ↑WBC", "correct": false}, {"label": "D", "text": "Pain, ↑WBC, ↑Bilirubin", "correct": false}], "correct_answer": "A. Pain, jaundice, fever", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cholangitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, leading to bacterial infection by organisms like Klebsiella, E. coli, Enterobacter, Pseudomonas, and <span class=\"customMeta\" data-dictid=\"e58661c5961692777184ecb7121396\">Citrobacter</span> species.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Charcot's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> - pain, jaundice, fever</strong></li>\n<li>Additional <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b2332a96a2169277718756eb10e3e7\">epigastrium</span> and right <span class=\"customMeta\" data-dictid=\"c8bf2605091692777189746f65e812\">hypochondrium</span> is common.</li>\n<li>Severe Form: <strong>Reynolds pentad</strong> - <strong>persistent pain, fever, jaundice, shock, and altered mental status</strong></li>\n<li>Indicates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> obstructive <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> count, bilirubin, and <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> levels.</li>\n<li>Chronic cases may show <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> or hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recurrent <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">Pyogenic</span> Cholangitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More common in East Asian populations, caused by <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> stones and infections</li>\n<li>Risk factors include <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> infections like <span class=\"customMeta\" data-dictid=\"1d97210e3416927771844d6a6b6242\">Clonorchis</span> sinensis and <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> lumbricoides.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/H5tjI0Crhg1hvI1YFJqL1748851326.mp3", "video": ""}, {"text": "A 40 year old patient is experiencing persistent abdominal pain and elevated serum amylase after undergoing ERCP. The pain began shortly after the procedure. Which of the following is the most likely cause of the patient's symptoms?", "options": [{"label": "A", "text": "Post-ERCP pancreatitis", "correct": true}, {"label": "B", "text": "Post-ERCP duodenal perforation", "correct": false}, {"label": "C", "text": "Post-ERCP cholangitis", "correct": false}, {"label": "D", "text": "Post-ERCP sphincter stenosis", "correct": false}], "correct_answer": "A. Post-ERCP pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PeS4s8k3o5lcS6Ykhx3B1748851199.mp3", "video": ""}, {"text": "A 55 year old male with history of obesity and a low-protein diet presents with intermittent abdominal pain, jaundice, and recurrent episodes of dark urine and light-colored stools. Recently, he developed a fever with chills. Blood tests show elevated WBC count and abnormal liver function tests. MRCP reveals multiple pigmented stones in the common bile duct and intrahepatic ducts. What is the most likely cause of his condition?", "options": [{"label": "A", "text": "Primary Choledocholithiasis", "correct": true}, {"label": "B", "text": "Secondary Choledocholithiasis", "correct": false}, {"label": "C", "text": "Gallstone ileus", "correct": false}, {"label": "D", "text": "Chronic Pancreatitis", "correct": false}], "correct_answer": "A. Primary Choledocholithiasis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary CBD stone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary CBD stone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formed inside the common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</li>\n<li>The most common stone is the brown stone.</li>\n<li>More common in developing countries due to <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> infestations such as <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> and <span class=\"customMeta\" data-dictid=\"1d97210e3416927771844d6a6b6242\">Clonorchis</span> sinensis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formed in the <span class=\"customMeta\" data-dictid=\"bec5d0b8cb1692777188267d64974a\">gall</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> which slips into the common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</li>\n<li>The most common type: is cholesterol stone</li>\n<li>More common in developed countries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biliary colic to non-specific <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n<li>Biliary colic is a sudden, severe, colicky pain in the right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> that radiates to the back and shoulder.</li>\n<li>It is precipitated by a <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> or heavy meal and can last for a few hours.</li>\n<li>The pain is typically located in the <span class=\"customMeta\" data-dictid=\"8ebae4796b16927771873812e5f9ed\">ep</span> igastrium and right hypochondrium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Jaundice, a yellowing of the skin and eyes, is the most common clinical manifestation of choledocholithiasis.</li>\n<li>It occurs due to the <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow, leading to the accumulation of <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> in the blood.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> associated with <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> is likely to be painful because the onset of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> is often acute.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The presence of fever with chills and rigors is suggestive of cholangitis, a serious <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of choledocholithiasis.</li>\n<li>Cholangitis occurs when the <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> leads to bacterial infection and inflammation.</li>\n<li><u>Charcot’s triad</u> : Pain + Fever + Jaundice</li>\n<li><u>Reynauld’s pentad</u>: Mental status changes + <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">Hypotension</span> + Charcot’s triad</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Changes in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and stool</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstruction of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> can lead to darkening of the <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and <span class=\"customMeta\" data-dictid=\"1b795394751692777191dd8d839fe7\">lightening</span> of the stools.</li>\n<li>Steatorrhea, or <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> stools, may occur due to the impaired <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of fat and <span class=\"customMeta\" data-dictid=\"8ddb9380a816927772028a1805805e\">fat-soluble vitamins</span> caused by the lack of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> in the intestines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pruritus (itching), loss of appetite, weight loss, nausea, and vomiting.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ljxeIfmBFuIpd7wInCLx1748849041.mp3", "video": ""}, {"text": "How many sphincters make up the Sphincter of Oddi Complex?", "options": [{"label": "A", "text": "12", "correct": false}, {"label": "B", "text": "9", "correct": false}, {"label": "C", "text": "6", "correct": false}, {"label": "D", "text": "4", "correct": true}], "correct_answer": "D. 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KrJXYtD8qBuDeWADtgHc1738739433.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S5BIZCrDasvQok2a5FTZ1748848639.mp3", "video": ""}, {"text": "During a gallbladder surgery, the surgeon identifies the hepatic artery running medially and carefully avoids injuring a structure located laterally to it. Which of the following is the most likely structure located lateral to the hepatic artery?", "options": [{"label": "A", "text": "Common hepatic duct", "correct": false}, {"label": "B", "text": "Portal vein", "correct": false}, {"label": "C", "text": "Cystic artery", "correct": false}, {"label": "D", "text": "Common bile duct", "correct": true}], "correct_answer": "D. Common bile duct", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Yt4FpkVn26n2OfadL3qZ1738738847.png", "https://image.prepladder.com/content/onOWscZ4OAFEH8xla7YY1738738959.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kssJfTxEieFX1cyfnnnD1748850548.mp3", "video": ""}, {"text": "Which artery primarily supplies the common hepatic duct and the common bile duct?", "options": [{"label": "A", "text": "Gastroduodenal artery", "correct": false}, {"label": "B", "text": "Pancreaticoduodenal artery", "correct": false}, {"label": "C", "text": "Right hepatic artery", "correct": true}, {"label": "D", "text": "Left hepatic artery", "correct": false}], "correct_answer": "C. Right hepatic artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yADeAaXZbrmWATnrRlAD1739878261.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4GKdcgqjXCplGTFP20dC1748848531.mp3", "video": ""}, {"text": "A 50 year old man presents with jaundice and abdominal pain one week after a cholecystectomy. Imaging confirms a bile duct injury with a complete transection of the common bile duct. What is the recommended management for this injury at this stage?", "options": [{"label": "A", "text": "Immediate surgical repair", "correct": false}, {"label": "B", "text": "Conservative management with antibiotics and observation", "correct": false}, {"label": "C", "text": "Delay repair for 4-6 weeks and then perform Roux-en-Y choledochojejunostomy", "correct": true}, {"label": "D", "text": "Endoscopic stenting and balloon dilation", "correct": false}], "correct_answer": "C. Delay repair for 4-6 weeks and then perform Roux-en-Y choledochojejunostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cx4Ze64t0pGJ7bkKdL1P1738768486.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Fs68kpuPHMaaqrW5IcL31748849825.mp3", "video": ""}, {"text": "A 40 year old male with a history of ulcerative colitis presents with fatigue, pruritus, jaundice, elevated ALP, and GGTP. The MRCP and Liver biopsy show the following findings. Despite endoscopic stenting, his symptoms persist, and liver function continues to decline. What is the most definitive treatment option for this patient?", "options": [{"label": "A", "text": "Antibiotics and cholestyramine", "correct": false}, {"label": "B", "text": "Endoscopic retrograde cholangiopancreatography", "correct": false}, {"label": "C", "text": "Liver transplantation", "correct": true}, {"label": "D", "text": "Operative resection", "correct": false}], "correct_answer": "C. Liver transplantation", "question_images": ["https://image.prepladder.com/content/fefIEGO4vk9U569H0Kzv1738762258.png", "https://image.prepladder.com/content/V9ADKKOrbydor447gQuS1738762357.png"], "explanation_images": ["https://image.prepladder.com/content/sSbfYMXcQdTMjShvls241738761938.png", "https://image.prepladder.com/content/qECP9Bp0olzt68svSxmS1738761975.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Labeled images</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRCP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Knipe H, Walizai T, Rasuli B\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/primary-sclerosing-cholangitis\" data-tags=\"\" height=\"260\" src=\"https://image.prepladder.com/content/sSbfYMXcQdTMjShvls241738761938.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Raul S. Gonzalez\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/liverPSC.html\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/qECP9Bp0olzt68svSxmS1738761975.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/j6E3sAPp9jglA6Vahw7s1747152952.mp3", "video": ""}, {"text": "A 45 year old male with a history of ulcerative colitis presents with jaundice, right upper quadrant pain, and intermittent fever. Laboratory tests reveal elevated serum ALP and gamma-glutamyl transpeptidase (GGTP). MRCP shows stricturing and beading of the bile ducts. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary sclerosing cholangitis", "correct": true}, {"label": "B", "text": "Acute cholangitis", "correct": false}, {"label": "C", "text": "Choledocholithiasis", "correct": false}, {"label": "D", "text": "Hepatocellular carcinoma", "correct": false}], "correct_answer": "A. Primary sclerosing cholangitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AAusS71WC9kdbiHaJQ8G1748849479.mp3", "video": ""}, {"text": "A 70 year old female presents with signs of severe cholangitis. Despite initial treatment with broad-spectrum antibiotics and an unsuccessful ERCP attempt, her condition continues to worsen. An ultrasound shows multiple stones and a severely dilated common bile duct. What is the next best step in management?", "options": [{"label": "A", "text": "Repeat ERCP", "correct": false}, {"label": "B", "text": "Percutaneous transhepatic cholangiography (PTC)", "correct": false}, {"label": "C", "text": "Open biliary decompression", "correct": true}, {"label": "D", "text": "Continued observation and supportive care", "correct": false}], "correct_answer": "C. Open biliary decompression", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7kwkrPqO3rIJ09PbtAkS1738760953.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rWr40eStYPVEymMhhlg41748849165.mp3", "video": ""}, {"text": "A 62 year old male presents with jaundice and severe abdominal pain in the right upper quadrant that started abruptly after a heavy meal. He also reports dark urine, pale stools, and intermittent fever with chills. An ultrasound shows a dilated common bile duct. ERCP is planned for stone removal. What is the maximum size of the stone that can typically be removed by ERCP without additional procedures?", "options": [{"label": "A", "text": "17 mm", "correct": false}, {"label": "B", "text": "15 mm", "correct": true}, {"label": "C", "text": "20 mm", "correct": false}, {"label": "D", "text": "25 mm", "correct": false}], "correct_answer": "B. 15 mm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DAlZae51VUzW5M0QeDmQ1739877724.png", "https://image.prepladder.com/content/JRzKucYXNTi4NEVns63A1739877767.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Choledocholithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound:</strong> Useful for detecting gallstones and CBD <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> but has limited sensitivity for CBD stones</li>\n<li><strong>MRCP:</strong> Non-invasive, excellent for visualizing <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and pathology.</li>\n<li><strong>ERCP:</strong> Highly sensitive, both <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> for CBD stones.</li>\n<li><strong>PTC:</strong> Used when ERCP is not feasible, such as post-gastrectomy patients or unsuccessful ERCP attempts.</li>\n<li><strong>EUS:</strong> <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> but accurate for diagnosing choledocholithiasis.</li>\n<li><strong>Blood Tests:</strong> ↑ bilirubin, ↑alkaline phosphatase, and ↑white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> indicate <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and possible complications like cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endoscopic Management:</strong> ERCP with <span class=\"customMeta\" data-dictid=\"175e83e48b1692777199af3924b28b\">sphincterotomy</span> and stone extraction; stenting if necessary.</li>\n<li><strong>Percutaneous Removal:</strong> Used when <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> access is difficult.</li>\n<li><strong>Surgery:</strong> Options include <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> and open choledocholithotomy, choledochoduodenostomy, and choledochojejunostomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cholangitis:</strong> Bacterial infection due to obstructed <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow, leading to fever, chills, right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, and jaundice.</li>\n<li><strong>Pancreatitis:</strong> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</li>\n<li><strong>Liver Damage:</strong> Prolonged <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> can cause <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> and liver failure.</li>\n<li><strong>Biliary Stricture:</strong> Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> can lead to the narrowing of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts.</li>\n<li><strong>Gallstone Ileus:</strong> Large <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> eroding into the intestine, causing mechanical obstruction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fMvYH5SY8ixwZsTTJfNf1748848809.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 32 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following risk factors is associated with both gallbladder cancer and cholangiocarcinoma?", "options": [{"label": "A", "text": "Gallstones", "correct": false}, {"label": "B", "text": "Porcelain gallbladder", "correct": false}, {"label": "C", "text": "Primary sclerosing cholangitis (PSC)", "correct": true}, {"label": "D", "text": "Hepatitis C virus infection", "correct": false}], "correct_answer": "C. Primary sclerosing cholangitis (PSC)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gallbladder Cancer </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cholangiocarcinoma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gallstones, <span class=\"customMeta\" data-dictid=\"e8d8ca06111692777196997de5e559\">porcelain</span> gallbladder, PSC, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> pancreatic-biliary junction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PSC, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> disease, hepatolithiasis, liver flukes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal pain, early satiety, anorexia, weight loss, jaundice, Courvoisier's sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar non-specific symptoms, jaundice, Courvoisier's sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>USG, CT, MRI/MRCP, elevated ALT, AST, CA19-9, and ERCP/PTC, <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> laparoscopy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tools and markers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> for <span class=\"customMeta\" data-dictid=\"e93e54afd9169277719731c7b12d94\">resectable</span> cases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatic/bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> resection, pancreaticoduodenectomy, <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for select cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor, low 5-year survival rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor, low 5-year survival rate</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sNdxqzmXzJzkDEnQZzUQ1748788291.mp3", "video": ""}, {"text": "A 65-year-old female presents with severe right upper quadrant pain, jaundice, and a history of recurrent cholangitis. Imaging reveals a cholecystocholedochal fistula involving up to two-thirds of the circumference of the common bile duct. Which type of Mirizzi syndrome is seen in this patient?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": true}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "C. Type III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gBgHYKxL2tElnsCU6aCr1740033396.png", "https://image.prepladder.com/content/CVysO91ygOQjyN8xmZoh1740033443.png", "https://image.prepladder.com/content/jWt4xDiBfXHobWwevx4T1740033454.png", "https://image.prepladder.com/content/9VFhkcna8KOtHfVWtXo41740033464.png", "https://image.prepladder.com/content/SbBAn6dHIiNBYgFFZqvd1740033483.png", "https://image.prepladder.com/content/yuqhvLkxrYfvJIuEsJY11740033498.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mirizzi’s Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extrinsic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the CBD/CHD by a large <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> stone in Hartmann's pouch;</p>\n<ul>\n<li>IA- the presence of <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n<li>IB- is obliterated <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"737\" src=\"https://image.prepladder.com/content/CVysO91ygOQjyN8xmZoh1740033443.png\" width=\"729\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The stone has eroded the CBD/CHD less than 1/3rd <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD forming a fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"590\" src=\"https://image.prepladder.com/content/jWt4xDiBfXHobWwevx4T1740033454.png\" width=\"583\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involving up to 2/3rd of the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of CBD/ CHD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"425\" src=\"https://image.prepladder.com/content/9VFhkcna8KOtHfVWtXo41740033464.png\" width=\"457\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (&gt;2/3rd) involving the entire <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"830\" src=\"https://image.prepladder.com/content/SbBAn6dHIiNBYgFFZqvd1740033483.png\" width=\"893\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TypeV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> with cholecystoenteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> without <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VA) or with</p>\n<p>gallstone <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VB)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"675\" src=\"https://image.prepladder.com/content/yuqhvLkxrYfvJIuEsJY11740033498.png\" width=\"541\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rsvUutZn4q7NWcdLOxYC1748774444.mp3", "video": ""}, {"text": "A 65-year-old female presents with right upper quadrant pain and nausea. An ultrasound reveals a 1.5 cm gallbladder polyp, and a follow-up scan shows an increase in size from the previous scan six months ago. She also has a history of gallstones. Which of the following factors increases the risk of invasive cancer in gallbladder polyps?", "options": [{"label": "A", "text": "Age less than 60 years", "correct": false}, {"label": "B", "text": "Presence of gallstones", "correct": true}, {"label": "C", "text": "Polyp size more than 0.5 cm", "correct": false}, {"label": "D", "text": "The same polyp size on repeated scans", "correct": false}], "correct_answer": "B. Presence of gallstones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5hmxhhAwafHIdW6ITNuB1740033799.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:378px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cholesterol polyp</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenomatous polyp</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common</li>\n<li>Small &lt;10 mm</li>\n<li>Multiple</li>\n<li>Benign</li>\n<li>Pedunculated</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less common</li>\n<li>Large &gt;10mm</li>\n<li>Single</li>\n<li>Premalignant</li>\n<li>Sessile</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TIriDXNKQFoDhRFrnGpz1748774631.mp3", "video": ""}, {"text": "A 75-year-old male in the ICU with sepsis and multiple organ failure develops sudden right upper quadrant pain and fever. Ultrasound reveals a distended gallbladder with thickened walls and no gallstones. Which of the following is not a predisposing factor for acalculous cholecystitis?", "options": [{"label": "A", "text": "Parenteral nutrition", "correct": false}, {"label": "B", "text": "Extensive burns", "correct": false}, {"label": "C", "text": "Hypertension", "correct": true}, {"label": "D", "text": "Diabetes", "correct": false}], "correct_answer": "C. Hypertension", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7uwLW6Z8wWTnAc3TdHP31748774115.mp3", "video": ""}, {"text": "A 75-year-old female with a history of cholelithiasis presents with acute abdominal pain, vomiting, and signs of bowel obstruction. O/E, she has abdominal distension and high-pitched bowel sounds. A radiograph shows pneumobilia and a calcified gallstone in the right lower quadrant. CT confirms an abnormal gallbladder with air and fluid accumulation. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Cholecystectomy and fistula repair", "correct": false}, {"label": "B", "text": "Endoscopic removal of the gallstone", "correct": false}, {"label": "C", "text": "Enterolithotomy", "correct": true}, {"label": "D", "text": "Conservative management with IV fluids and antibiotics", "correct": false}], "correct_answer": "C. Enterolithotomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gallbladder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> and pancreas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small intestine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute cholecystitis</li>\n<li>Chronic cholecystitis</li>\n<li>Mucocele</li>\n<li>Empyema</li>\n<li>Gangrene</li>\n<li>Perforation</li>\n<li>Carcinoma gallbladder</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CBD stones</li>\n<li>Biliary <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (Jaundice)</li>\n<li>Acute pancreatitis</li>\n<li>Mirizzi syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gallstone <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> leading to intestinal obstruction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KAXL7raQh9tKKc2qBO6V1748773991.mp3", "video": ""}, {"text": "A 65-year-old male with a history of diabetes presents with severe right upper quadrant pain, fever, and jaundice. Imaging reveals gas within the gallbladder wall. Which of the following organisms is most likely to be the causative agent in this patient's condition?", "options": [{"label": "A", "text": "Clostridium perfringens", "correct": true}, {"label": "B", "text": "Staphylococcus aureus", "correct": false}, {"label": "C", "text": "Streptococcus pyogenes", "correct": false}, {"label": "D", "text": "Pseudomonas aeruginosa", "correct": false}], "correct_answer": "A. Clostridium perfringens", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4WN95CHBywEftAy9bACF1740033225.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ta7YjxEvGkEZg4RQKd021748773859.mp3", "video": ""}, {"text": "A 70-year-old female presents with vague right upper quadrant discomfort, but she is mostly asymptomatic. An abdominal X-ray reveals extensive calcification of the gallbladder wall. There is bluish appearance and brittle consistency of the gallbladder. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gallbladder carcinoma", "correct": false}, {"label": "B", "text": "Cholesterolosis", "correct": false}, {"label": "C", "text": "Porcelain gallbladder", "correct": true}, {"label": "D", "text": "Acute cholecystitis", "correct": false}], "correct_answer": "C. Porcelain gallbladder", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/P5NVtbVLVviwJC0K6Xvp1740033931.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/L1jzLWEtOKJVKcAyscI91748775079.mp3", "video": ""}, {"text": "Which of the following is not a risk factor for gallbladder carcinoma?", "options": [{"label": "A", "text": "Smoking", "correct": true}, {"label": "B", "text": "Gallstones", "correct": false}, {"label": "C", "text": "Porcelain gallbladder", "correct": false}, {"label": "D", "text": "Hepatitis B", "correct": false}], "correct_answer": "A. Smoking", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors For <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> GB</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gallstones</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>90% of <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> cases are associated with gallstones. <strong>(Option B ruled out)</strong></li>\n<li>The risk of developing <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> disease is 7-10 times higher than in the general population.</li>\n<li>Relative risk based on stone size:\n\t\t\t\t<ul>\n<li>Less than 2 cm: Lower risk</li>\n<li>2-3 cm: <span class=\"customMeta\" data-dictid=\"8bbe99007e1692777197cdb196b181\">Relative risk</span> of 2.5</li>\n<li>More than 3 cm: <span class=\"customMeta\" data-dictid=\"8bbe99007e1692777197cdb196b181\">Relative risk</span> of 10 or more</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Conditions</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Choledochal cyst</li>\n<li>Anomalous <span class=\"customMeta\" data-dictid=\"c2ae5e9c971692777194234dc59b3b\">pancreaticobiliary</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (20%)</li>\n<li>Cholesteroses of the gallbladder</li>\n<li>Gallbladder polyps (more than 1 cm in size, more than 3 in number, or <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyps)</li>\n<li>Porcelain gallbladder: 25% risk of <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation, with 90% being <span class=\"customMeta\" data-dictid=\"16690cd26b169277719085df163f96\">inoperable</span> tumours <strong>(Option C ruled out )</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infections and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> Conditions</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"f2f6f9068216927772016cacf26183\">typhoid</span> carriers</li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</li>\n<li>Hepatitis B and <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> C virus infections <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other factors:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Polypoid lesions (GB polyp)</li>\n<li>Xanthogranulomatous cholecystitis</li>\n<li>Nitrosamines</li>\n<li>Carcinogens</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VfGhGsVMQoVb5SCkMRyU1748788095.mp3", "video": ""}, {"text": "A 50 y/o woman undergoing laparoscopic cholecystectomy is found to have a structure that appears to have a spiral configuration. What is the most likely anatomical feature being observed?", "options": [{"label": "A", "text": "Vasa vasorum", "correct": false}, {"label": "B", "text": "Sphincter of Oddi", "correct": false}, {"label": "C", "text": "Accessory Pancreatic Duct", "correct": false}, {"label": "D", "text": "Valves of Heister", "correct": true}], "correct_answer": "D. Valves of Heister", "question_images": ["https://image.prepladder.com/content/D973CpzH6Iaz8XzzOCKr1740030274.png"], "explanation_images": ["https://image.prepladder.com/content/FNOcFFMwvaefXfLxF2KS1740030322.png", "https://image.prepladder.com/content/zGVAugveqsA9rPz9VWMs1740030358.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CCBwEZclmD2eGM1QlCpA1748790124.mp3", "video": ""}, {"text": "A 45 y/o woman presents to the ER with severe right upper quadrant abdominal pain, nausea, and vomiting. She has a history of gallstones and is diagnosed with acute cholecystitis. During laparoscopic cholecystectomy, the surgeon encounters difficulty identifying the cystic artery due to inflammation. Which anatomical landmarks within Calot's triangle would be most helpful in locating the cystic artery?", "options": [{"label": "A", "text": "Gallbladder fundus", "correct": false}, {"label": "B", "text": "Cystic lymph node", "correct": true}, {"label": "C", "text": "Common bile duct", "correct": false}, {"label": "D", "text": "Portal vein", "correct": false}], "correct_answer": "B. Cystic lymph node", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kIBXkpuRtg0otI5uB2Pw1740032071.png", "https://image.prepladder.com/content/WvF5PFFH6lpZHrx6OM191740032120.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Correct Answer: B) Cystic lymph node Explanation:</li><li>↳ Correct Answer: B) Cystic lymph node</li><li>↳ Correct Answer: B) Cystic lymph node</li><li>↳ Explanation:</li><li>↳ Explanation:</li><li>↳ The cystic lymph node, or Lund’s node , is located within Calot's triangle.</li><li>↳ cystic lymph node, or Lund’s node</li><li>↳ It serves as an important landmark for identifying the cystic artery.</li><li>↳ Inflammation or anatomical variations can obscure typical landmarks, making the cystic lymph node a valuable reference point during surgery.</li><li>↳ Calot's triangle, also known as the cystohepatic triangle, is an important anatomical area during gallbladder surgery. The boundaries of Calot's triangle are defined by:</li><li>↳ Cystic duct (lateral boundary) Common hepatic duct (medial boundary) The inferior surface of the liver (superior boundary)</li><li>↳ Cystic duct (lateral boundary)</li><li>↳ Cystic duct (lateral boundary)</li><li>↳ Common hepatic duct (medial boundary)</li><li>↳ Common hepatic duct (medial boundary)</li><li>↳ The inferior surface of the liver (superior boundary)</li><li>↳ The inferior surface of the liver (superior boundary)</li><li>↳ The contents of Calot's triangle typically include the cystic artery, which supplies blood to the gallbladder, and the cystic lymph node (Lund’s node). Identification of these structures is crucial during a cholecystectomy to avoid accidental injury to the biliary or vascular systems.</li><li>↳ Note: The term \"hepatocystic triangle\" is often used interchangeably with Calot's triangle. It emphasizes the inclusion of the liver's inferior surface as part of the boundaries, along with the cystic duct and the common hepatic duct.</li><li>↳ Note:</li><li>↳ Gallbladder fundus (Option A): The fundus of the gallbladder is the uppermost part and does not provide a useful landmark for locating the cystic artery during dissection within Calot's triangle.</li><li>↳ Gallbladder fundus (Option A):</li><li>↳ Common bile duct (Option C): The common bile duct lies outside the typical boundaries of Calot's triangle; the correct duct involved is the common hepatic duct.</li><li>↳ Common bile duct (Option C):</li><li>↳ Portal vein (Option D): The portal vein is located posterior to the hepatoduodenal ligament and is not within Calot's triangle. It does not serve as a landmark for identifying the cystic artery.</li><li>↳ Portal vein (Option D):</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/afEMAyKGaw5Gc2wjjoRS1748790006.mp3", "video": ""}, {"text": "A 45 y/o patient presents with recurrent right upper quadrant pain and nausea. Imaging reveals a pathological outpouching in the infundibular region of the gallbladder containing multiple gallstones. What is this feature known as?", "options": [{"label": "A", "text": "Phrygian cap", "correct": false}, {"label": "B", "text": "Floating gallbladder", "correct": false}, {"label": "C", "text": "Hartmann's pouch", "correct": true}, {"label": "D", "text": "Gallbladder carcinoma", "correct": false}], "correct_answer": "C. Hartmann's pouch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CYmctJ6K4QBk0COVciB81740032436.png", "https://image.prepladder.com/content/z9cCMhc6G8HjaQ88eRkN1740032482.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Sqo5rWzsGoPDDyLjPLq11748789902.mp3", "video": ""}, {"text": "Which layer of the gastric wall is considered the strongest?", "options": [{"label": "A", "text": "Mucosa", "correct": false}, {"label": "B", "text": "Submucosa", "correct": true}, {"label": "C", "text": "Muscularis Externa", "correct": false}, {"label": "D", "text": "Serosa", "correct": false}], "correct_answer": "B. Submucosa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Layers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serosa</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Outermost layer</li>\n<li>Covered by peritoneum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscularis Propria / <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">Muscularis</span> externa</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Divided into\n\t\t\t\t<ul>\n<li>Outer <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> layer</li>\n<li>Inner <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> layer</li>\n</ul>\n</li>\n<li>Contains Auerbach Plexus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submucosa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collagen-rich <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue layer</li>\n<li>Strongest</li>\n<li>It contains a network of blood vessels, lymphatics, and Meissner Plexus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucosa </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Has 3 layers</p>\n<ul>\n<li>Surface <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> - outermost layer in contact with the lumen</li>\n<li>Lamina Propria - <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue layer</li>\n<li>Muscularis <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">Mucosa</span> - <span class=\"customMeta\" data-dictid=\"0d036182fc16927771975433efc65e\">rugae</span> formation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Auerbach Plexus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meissner’s Plexus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peristaltic function</li>\n<li>Located between the inner <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> and outer <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> layer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Villous <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and intestinal secretion</li>\n<li>Located in the <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> between the <span class=\"customMeta\" data-dictid=\"9c498ba4dd1692777193470f4af537\">muscularis</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and the inner <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> layer</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JxLi3Dk5DlXDYoqhmcSn1748789792.mp3", "video": ""}, {"text": "A 65 y/o female presents with a 3-month history of intermittent upper right quadrant pain, weight loss, and loss of appetite. She has jaundice and a palpable mass in the right upper quadrant. Laboratory tests reveal mild anaemia, leukocytosis, and elevated CA19-9 and carcinoembryonic antigen. USG suggests a gallbladder mass and a CT scan confirms the mass without distant metastases. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Immediate laparoscopic cholecystectomy", "correct": false}, {"label": "B", "text": "Percutaneous biopsy of the gallbladder mass", "correct": false}, {"label": "C", "text": "Referral for palliative chemotherapy", "correct": false}, {"label": "D", "text": "Laparoscopic examination for staging", "correct": true}], "correct_answer": "D. Laparoscopic examination for staging", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9iz10g1YIphmnojWiMXC1748788499.mp3", "video": ""}, {"text": "Which of the following surgeons is correctly matched with their pioneering laparoscopic procedure and year of achievement?", "options": [{"label": "A", "text": "Professor Erich Mühe - First video-assisted laparoscopic cholecystectomy in 1987", "correct": false}, {"label": "B", "text": "Dr. Philippe Mouret - First laparoscopic cholecystectomy in 1985", "correct": false}, {"label": "C", "text": "Dr. Kurt Semm - First laparoscopic appendicectomy in 1983", "correct": true}, {"label": "D", "text": "Professor Erich Mühe - First laparoscopic appendicectomy in 1983", "correct": false}], "correct_answer": "C. Dr. Kurt Semm - First laparoscopic appendicectomy in 1983", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YNxI0XFIEIKfrSvDUs9N1748789029.mp3", "video": ""}, {"text": "A 62-year-old male presents with intermittent right upper quadrant pain and nausea. An ultrasound shows significant thickening of the gallbladder wall and hyperproliferation of the mucosa. Which of the following is NOT a USG finding in Adenomyomatosis?", "options": [{"label": "A", "text": "Diamond ring sign", "correct": false}, {"label": "B", "text": "Comet tail artefacts", "correct": false}, {"label": "C", "text": "V-shaped artefacts", "correct": false}, {"label": "D", "text": "Porcelain appearance", "correct": true}], "correct_answer": "D. Porcelain appearance", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ttSJYia7wn5y1XVc7qYQ1740034061.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/78qC6psEjZE2EqqR3mAl1748774870.mp3", "video": ""}, {"text": "A 58-year-old male, with past h/o cholesterol stones, presents with intermittent right upper quadrant pain and occasional nausea.USG reveals the gallbladder mucosa has a coarse, granular appearance with small nodules and some larger polypoid formations. On performing laparoscopic cholecystectomy of this patient, the following appearance of the gall bladder was observed. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": false}, {"label": "B", "text": "Porcelain gallbladder", "correct": false}, {"label": "C", "text": "Cholesterolosis", "correct": true}, {"label": "D", "text": "Gallbladder carcinoma", "correct": false}], "correct_answer": "C. Cholesterolosis", "question_images": ["https://image.prepladder.com/content/nYYRQn1ENOlIXL2sdQsT1740033860.png"], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/toQP7e1xySOdfsMsx4dA1748774760.mp3", "video": ""}, {"text": "A 65 y/o presents with jaundice, weight loss, and abdominal pain. O/E a palpable mass is noted in the right upper quadrant. Imaging studies reveal a mass involving the gallbladder, with signs of local invasion but no distant or lymph node metastasis. A biopsy confirms gallbladder carcinoma. Based on the TNM classification, which stage is most likely for this patient's tumour?", "options": [{"label": "A", "text": "T1a N0 M0", "correct": false}, {"label": "B", "text": "T2b N1 M0", "correct": false}, {"label": "C", "text": "T3 N0 M0", "correct": true}, {"label": "D", "text": "T4 N2 M1", "correct": false}], "correct_answer": "C. T3 N0 M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carcinoma in situ</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria or muscle layer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades muscle layer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades perimuscular <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor does not extend to serosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends to serosa, but does not invade the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor perforates <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> and/or invades liver/adjacent organs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades main <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein/hepatic artery/multiple <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> organs</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastases to 1-3 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastases to &gt;3 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/llYHxpUx15oN2KtOkqMz1748788693.mp3", "video": ""}, {"text": "A 58 y/o presents with jaundice, weight loss, and upper right abdominal pain. Imaging studies including CT and MRI reveal a mass in the gallbladder with local invasion into the liver but no distant metastasis. The patient undergoes a laparoscopic examination confirming the staging. What is the most appropriate treatment approach for this patient?", "options": [{"label": "A", "text": "Endoscopic stenting to relieve jaundice", "correct": false}, {"label": "B", "text": "Radical en bloc resection of the gallbladder, liver wedge, and regional lymph nodes", "correct": true}, {"label": "C", "text": "Palliative chemotherapy", "correct": false}, {"label": "D", "text": "No further treatment if the tumor is confined to the mucosa", "correct": false}], "correct_answer": "B. Radical en bloc resection of the gallbladder, liver wedge, and regional lymph nodes", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/psEkFt0nHc1xoZ0uScQ01748788863.mp3", "video": ""}, {"text": "A 45-y/o female presents with symptomatic gallstones and is scheduled for laparoscopic cholecystectomy. During the procedure, the surgeon encounters difficulty due to unexpected anatomical variations. The right hepatic artery appears very tortuous and is located close to the cystic duct. What is the most likely anatomical anomaly encountered in this case?", "options": [{"label": "A", "text": "Phrygian cap", "correct": false}, {"label": "B", "text": "Moynihan Hump", "correct": true}, {"label": "C", "text": "Floating Gallbladder", "correct": false}, {"label": "D", "text": "Mirizzi Syndrome", "correct": false}], "correct_answer": "B. Moynihan Hump", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FkdLhzPAA79Lh0BN0UgM1740033293.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vl48WaWla95Y5euvc00D1747152568.mp3", "video": ""}, {"text": "A 58-year-old male presents with right upper quadrant pain, jaundice, and fever. Imaging reveals a gallstone eroding less than one-third of the circumference of the common bile duct. What is the management?", "options": [{"label": "A", "text": "Bilio-enteric anastomosis", "correct": false}, {"label": "B", "text": "Percutaneous cholecystostomy", "correct": false}, {"label": "C", "text": "Subtotal/Partial cholecystectomy + ERCP stenting", "correct": false}, {"label": "D", "text": "Partial cholecystectomy with choledochoplasty", "correct": true}], "correct_answer": "D. Partial cholecystectomy with choledochoplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XPxq1F110y7Uc7kRGm3j1740033722.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mirizzi’s Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extrinsic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the CBD/CHD by a large <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> stone in Hartmann's pouch;</p>\n<ul>\n<li>IA- the presence of <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n<li>IB- is obliterated <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subtotal/Partial <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> + <span class=\"customMeta\" data-dictid=\"b2276d3d4c16927771872281723792\">ERCP</span> stenting<br/>\n<strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The stone has eroded the CBD/CHD less than 1/3rd <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD forming a fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> with choledochoplasty</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involving up to 2/3rd of the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of CBD/ CHO</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> with choledochoplasty</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (&gt;2/3rd) involving the entire <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilio-enteric anastomosis<br/>\n<strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TypeV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> with cholecystoenteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> without <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VA) or with</p>\n<p>gallstone <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VB)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilio-enteric anastomosis</p>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lSOocPVEIkmvX6544An41745394109.mp3", "video": ""}, {"text": "A 70-year-old critically ill male in the ICU with sepsis and multiple organ failure presents with sudden onset of right upper quadrant pain, fever, and jaundice. Bedside ultrasonography shows a distended gallbladder with thickened walls and pericholecystic fluid but no gallstones. What is the treatment of choice for this patient?", "options": [{"label": "A", "text": "Laparoscopic cholecystectomy", "correct": false}, {"label": "B", "text": "Oral antibiotics and observation", "correct": false}, {"label": "C", "text": "Endoscopic retrograde cholangiopancreatography (ERCP)", "correct": false}, {"label": "D", "text": "Percutaneous cholecystostomy", "correct": true}], "correct_answer": "D. Percutaneous cholecystostomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer:D) &lt;span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\"&gt;Percutaneous&lt;/span&gt; cholecystostomy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Investigation of Choice for Acalculous Cholecystitis</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Preferred <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</strong></li>\n<li>Can be performed bedside in the ICU</li>\n<li>Detects distended gallbladder, thickened wall, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> sludge, pericholecystic fluid, and <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aids in diagnosis</li>\n<li>Provides comprehensive <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> and chest evaluation to rule out other infection sources</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIDA Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Useful if showing non-visualization of the gallbladder</li>\n<li>Less sensitive with higher <span class=\"customMeta\" data-dictid=\"b0151941a0169277720265b58da84e\">false-positive</span> rates in prolonged fasting, total <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> nutrition, or liver disease patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RGiqATGDpgT2lA1DXFya1748774266.mp3", "video": ""}, {"text": "A 45-year-old woman with asymptomatic gallstones is being evaluated for prophylactic cholecystectomy. Which of the following is NOT typically considered an indication for prophylactic cholecystectomy?", "options": [{"label": "A", "text": "Gallstones larger than 3 cm", "correct": false}, {"label": "B", "text": "Presence of gallstones in the common bile duct", "correct": false}, {"label": "C", "text": "Asymptomatic small gallbladder polyps", "correct": true}, {"label": "D", "text": "Undergoing bariatric surgery", "correct": false}], "correct_answer": "C. Asymptomatic small gallbladder polyps", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oWVc4HXq0kCiwpQwNZU71748773690.mp3", "video": ""}, {"text": "Which of the following is an indication for dissolution therapy in gallstone management?", "options": [{"label": "A", "text": "Non-functioning gallbladder", "correct": false}, {"label": "B", "text": "Stone larger than 1.5 cm", "correct": false}, {"label": "C", "text": "Cholesterol stones which are typically radiolucent", "correct": true}, {"label": "D", "text": "Multiple stones", "correct": false}], "correct_answer": "C. Cholesterol stones which are typically radiolucent", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rSvdQhrRA9f3sUOOruCm1748773495.mp3", "video": ""}, {"text": "A 60-year-old patient with a history of diabetes and hypertension presents with right upper quadrant pain, fever, and elevated white blood cell count. According to the Tokyo Guidelines (2013/2018), what is the recommended treatment approach if the patient is diagnosed with Grade II acute cholecystitis and does not respond to antibiotic treatment and supportive care?", "options": [{"label": "A", "text": "Early laparoscopic cholecystectomy within 5-7 days.", "correct": false}, {"label": "B", "text": "Immediate discharge with oral antibiotics.", "correct": false}, {"label": "C", "text": "Early gallbladder drainage followed by delayed/elective cholecystectomy.", "correct": true}, {"label": "D", "text": "Delayed cholecystectomy after 6 weeks.", "correct": false}], "correct_answer": "C. Early gallbladder drainage followed by delayed/elective cholecystectomy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild</strong> Cholecystitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Moderate</strong><strong> </strong>Cholecystitis</li>\n<li>Along with one of the following\n\t\t\t\t<ul>\n<li>Increased TLC (&gt; 18,000/mm<sup>3</sup>)</li>\n<li>Lasting &gt; 72 hrs</li>\n<li>Palpable tender mass in RUQ of the abdomen</li>\n<li>Biliary peritonitis, pericholecystic abscess, gangrenous cholecystitis, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> abscess, emphysematous cholecystitis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe </strong>Cholecystitis along with organ dysfunction</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>If fit for surgery- then do early <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</li>\n<li>If unfit:</li>\n</ol>\n<ul>\n<li>Give antibiotics and supportive care</li>\n<li>Observe</li>\n<li>Then do delayed <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First antibiotics and supportive care are to be given</p>\n\t\t\t \n\n\t\t\t<ol>\n<li>If fit for surgery- then do early <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</li>\n<li>If unfit:</li>\n</ol>\n<ul>\n<li>GB <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> via tube <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> (tube compresses GB, hence causing a decrease in inflammation)</li>\n<li>Then do delayed <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First antibiotics and supportive care are to be given</p>\n\t\t\t \n\n\t\t\t<ol>\n<li>If no negative predictive factors and good performance status:</li>\n</ol>\n<ul>\n<li>Then do early <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</li>\n</ul>\n<ol>\n<li>If negative predictive factors are present</li>\n</ol>\n<ul>\n<li>Then do Tube cholecystectomy/drainage first.</li>\n<li>If the patient then shows\n\t\t\t\t<ul>\n<li><u>Good performance status</u>- do delayed <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</li>\n<li><u>Poor performance status</u>- observe</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xaJNXU1uHzG6BEwPzTFs1748773204.mp3", "video": ""}, {"text": "A 45-year-old patient presents with right upper quadrant (RUQ) pain and fever. According to the Tokyo Guidelines, which combination of findings would confirm a diagnosis of acute cholecystitis?", "options": [{"label": "A", "text": "RUQ tenderness, elevated C-reactive protein, gallbladder wall thickening on USG.", "correct": true}, {"label": "B", "text": "Murphy's sign, fever, normal gallbladder wall on USG.", "correct": false}, {"label": "C", "text": "Palpable RUQ mass, normal white blood cell count, pericholecystic fluid on USG.", "correct": false}, {"label": "D", "text": "RUQ pain, elevated C-reactive protein, no imaging finding", "correct": false}], "correct_answer": "A. RUQ tenderness, elevated C-reactive protein, gallbladder wall thickening on USG.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tokyo Guidelines for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">Cholecystitis</span> (2013/2018)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A) Local Signs of Inflammation</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Murphy's sign</li>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RUQ) pain/ tenderness, or a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B) <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> Signs of Inflammation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Elevated CRP</li>\n<li>Elevated WBC</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C) <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Findings:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gallbladder wall thickening (&gt;3 mm)</li>\n<li>Pericholecystic fluid,</li>\n<li>Ultrasonographic Murphy's sign.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MMR0t3kBt0N8pEgZ0j0k1747829335.mp3", "video": ""}, {"text": "An ultrasound image of the gallbladder is consistent with a congenital anatomical variant. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Floating gallbladder", "correct": false}, {"label": "B", "text": "Accessory gallbladder", "correct": false}, {"label": "C", "text": "Phrygian cap", "correct": true}, {"label": "D", "text": "Gallbladder septum", "correct": false}], "correct_answer": "C. Phrygian cap", "question_images": ["https://image.prepladder.com/content/j1znxF4ON4MB3wAQZn1F1740029953.png"], "explanation_images": ["https://image.prepladder.com/content/NRzetpb34yKfQp24TF3X1740030025.png", "https://image.prepladder.com/content/HXBQPKTH28GiQG3qbJ6V1740030066.png", "https://image.prepladder.com/content/Dm4Dd9bSunH3MUjFrZCC1740030102.png", "https://image.prepladder.com/content/fiH2JwS83uggdlNnTT1I1740030147.png", "https://image.prepladder.com/content/LcISp3pgzqr9BcsUeIgY1740030194.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LtfktkHk4eknDOK7Og6a1746104658.mp3", "video": ""}, {"text": "A 45 y/o woman presents with severe right upper quadrant pain, fever, and nausea. She has a history of pain after fatty meals. O/E, she has right upper quadrant tenderness and a positive Murphy's sign. Lab tests show elevated alkaline phosphatase, bilirubin, transaminases, and leukocytosis. Which investigation is best to confirm this patient’s diagnosis?", "options": [{"label": "A", "text": "USG- Sonographic Murphy's sign positive.", "correct": false}, {"label": "B", "text": "Plain X-Ray- Identifies radio-opaque gallstones", "correct": false}, {"label": "C", "text": "CT Scan- Pericholecystic fluid, Impacted stones, gallbladder wall thickness", "correct": false}, {"label": "D", "text": "HIDA Scan- Non-visualization of the gallbladder", "correct": true}], "correct_answer": "D. HIDA Scan- Non-visualization of the gallbladder", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Zm6DszXYhXcxOnywhJTX1740032573.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ASPECT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INVESTIGATIONS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Investigation of Choice/ Initial Inv.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ultrasound Abdomen:</strong></p>\n<ul>\n<li>Reveals the presence or absence of gallstones.</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> shadowing</li>\n<li>Thickening of the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> wall.</li>\n<li>Sonographic Murphy's sign may be positive. ( <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> due to pressure of the <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> over the visualized gallbladder) <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gold Standard</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Combination of clinical assessment, laboratory findings, and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> results:</strong></p>\n<ul>\n<li><strong>Patient history</strong>: This includes the presence of symptoms like right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, fever, and a positive Murphy's sign on physical examination.</li>\n<li><strong>Laboratory tests</strong>: Findings might include mild elevations in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase, bilirubin, transaminases, and leukocytosis.</li>\n<li><strong>Imaging</strong>: <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> is the primary <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> tool, with <span class=\"customMeta\" data-dictid=\"d9dbeeaad416927771897ad0e05fe9\">HIDA</span> scans and CT scans serving as supplementary tools when needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>HIDA/PIPIDA <span class=\"customMeta\" data-dictid=\"4dd949a23a1692777197a5627fa8d8\">Radioisotope</span> Study</strong>:\n\t\t\t\t<ul>\n<li>Useful for assessing <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> visualization.</li>\n<li>Non-visualization of the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> is diagnostic.</li>\n</ul>\n</li>\n<li><strong>CT Scan Abdomen</strong>:\n\t\t\t\t<ul>\n<li>Identifies perforation, pericholecystic fluid, <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> stones, <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> wall thickness, and edema. <strong>(Option C)</strong></li>\n<li>Useful for detecting stones in the common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CBD).</li>\n</ul>\n</li>\n<li><strong>Plain <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> Abdomen</strong>:\n\t\t\t\t<ul>\n<li>Identifies radio-opaque gallstones (10% of cases). <strong>(Option B)</strong></li>\n<li>Rules out other causes of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n<li>May show gas in the emphysematous gallbladder.</li>\n<li>Useful to rule out duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> or peritonitis.</li>\n</ul>\n</li>\n<li><strong>Liver Function Tests (LFT)</strong></li>\n<li><strong>Total White <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">Blood Cell Count</span> (WBC Count)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mJxKBbxZh5YcBa4NVu5U1748789634.mp3", "video": ""}, {"text": "A 45 y/o woman presents to the ER with severe right upper quadrant pain radiating to her back. She has a h/o gallstones. O/E, she exhibits tenderness in the right upper quadrant. An abdominal CT scan shows a characteristic triradiate pattern of gas within a gallstone. Based on the CT findings, which of the following signs is most likely being described?", "options": [{"label": "A", "text": "Murphy sign", "correct": false}, {"label": "B", "text": "Mermaid sign", "correct": false}, {"label": "C", "text": "Stellate scar sign", "correct": false}, {"label": "D", "text": "Mercedes-Benz sign", "correct": true}], "correct_answer": "D. Mercedes-Benz sign", "question_images": ["https://image.prepladder.com/content/KuUoKFyHJlEMWzp665Yu1738814598.png"], "explanation_images": ["https://image.prepladder.com/content/ouXGfAmUNLCvlEnTBr9a1740032766.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wTKl4WLpuUL7bPzAkk2h1748789492.mp3", "video": ""}, {"text": "Which of the following statements accurately describes a characteristic of pigment stones?", "options": [{"label": "A", "text": "Black pigment stones are associated with bacterial β-glucuronidase activity in the bile duct.", "correct": false}, {"label": "B", "text": "Black pigment stones are associated with hemolysis.", "correct": true}, {"label": "C", "text": "Brown pigment stones are associated with excess bilirubin from hemolysis.", "correct": false}, {"label": "D", "text": "Black pigment stones are primarily composed of calcium bilirubinate and cholesterol.", "correct": false}], "correct_answer": "B. Black pigment stones are associated with hemolysis.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EQ4WRh91sQTW95GaoSgQ1740033000.png", "https://image.prepladder.com/content/DFCltvGLrVC8XXk8EbtK1740033051.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Black <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">Pigment</span> Stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Brown <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">Pigment</span> Stones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Insoluble <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> polymer, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> phosphate, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> bicarbonate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Calcium bilirubinate, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> palmitate, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> stearate, cholesterol<strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gallbladder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bile ducts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hemolysis (hereditary spherocytosis, sickle cell disease), cirrhosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bile stasis, infection, foreign bodies or parasites in the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (Clonorchis sinensis, <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> lumbricoides)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> from <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> precipitates in the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bacterial β-glucuronidase deconjugates <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> in the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct; unconjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> precipitates <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"><img alt=\"\" data-author=\"Portincasa, Piero &amp; Molina Molina, Emilio &amp; Garruti, Gabriella &amp; Wang, David.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Human-gallbladder-stones-Pure-cholesterol-stones-with-spherical-shape-and-morular_fig1_331138249\" data-tags=\"\" height=\"3359\" src=\"https://image.prepladder.com/content/EQ4WRh91sQTW95GaoSgQ1740033000.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"><img alt=\"\" data-author=\"Portincasa, Piero &amp; Molina Molina, Emilio &amp; Garruti, Gabriella &amp; Wang, David.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Human-gallbladder-stones-Pure-cholesterol-stones-with-spherical-shape-and-morular_fig1_331138249\" data-tags=\"\" height=\"2618\" src=\"https://image.prepladder.com/content/DFCltvGLrVC8XXk8EbtK1740033051.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YV2QLVzohrh4cjvINSSN1748789329.mp3", "video": ""}, {"text": "A 49-y/o woman presents with intermittent right upper quadrant pain that worsens after fatty meals. She has a history of Sickle cell disease and has been on total parenteral nutrition (TPN) for the past six months due to severe Crohn's disease post-ileal resection. She also gives a h/o OCP usage for 5 years. The patient underwent cholecystectomy which showed the following finding. Which of the following factors is least likely to contribute to the formation of this patient's condition?", "options": [{"label": "A", "text": "Total parenteral nutrition", "correct": false}, {"label": "B", "text": "Sickle cell disease", "correct": true}, {"label": "C", "text": "Ileal resection due to Crohn's disease", "correct": false}, {"label": "D", "text": "OCP usage", "correct": false}], "correct_answer": "B. Sickle cell disease", "question_images": ["https://image.prepladder.com/content/NVtJXHjJhla4GJ2xiAuh1740033132.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Cholesterol Gallstones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Formation Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Cholesterol precipitates out into crystals when the concentration exceeds the solubility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Contributing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<ul>\n<li>Obesity</li>\n<li>High-calorie diet</li>\n<li>Oral contraceptives <strong>(Option D ruled out) </strong></li>\n<li>Ileal disease/resection <strong>(Option C ruled out)</strong></li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> emptying</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Supersaturation of Bile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>High cholesterol and <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> concentrations in <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> secreted from the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>The concentration of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> in the Gallbladder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Bile is concentrated through the <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of water and sodium, increasing solutes and calcium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Crystal Nucleation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Cholesterol crystallizes when concentration exceeds solubility; accelerated by glycoproteins and immunoglobulins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Gallbladder Dysmotility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> due to <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> motility, promoting stone formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:middle\">\n<ul>\n<li>Prolonged fasting</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> <strong>(Option A ruled out)</strong></li>\n<li>Vagotomy</li>\n<li>Use of <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5BRj4IcTA72mNoMbDjFp1748789193.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 40 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is the most common type of primary liver tumor?", "options": [{"label": "A", "text": "Metastasis", "correct": false}, {"label": "B", "text": "Hepatocellular carcinoma", "correct": true}, {"label": "C", "text": "Hepatoblastoma", "correct": false}, {"label": "D", "text": "Hemangioma", "correct": false}], "correct_answer": "B. Hepatocellular carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/g1bFiQ8GqmKiz6eX7BGc1744894739.mp3", "video": ""}, {"text": "A 55-year-old male patient with a history of chronic hepatitis B presents with abdominal discomfort and weight loss. Imaging studies reveal a primary liver tumor with multiple metastatic lesions. Considering the typical metastatic pattern of liver tumors, what is the most likely site of these metastases?", "options": [{"label": "A", "text": "Bones", "correct": false}, {"label": "B", "text": "Brain", "correct": false}, {"label": "C", "text": "Lungs", "correct": true}, {"label": "D", "text": "Kidneys", "correct": false}], "correct_answer": "C. Lungs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/I9mv0vH1RlZNIFc4DzrA1744894885.mp3", "video": ""}, {"text": "A 45-year-old woman is incidentally found to have a 5 cm hepatic lesion on an ultrasound performed for evaluation of vague abdominal discomfort. A contrast-enhanced MRI shows a lesion with peripheral nodular enhancement and centripetal filling in the delayed phase. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Immediate surgical resection", "correct": false}, {"label": "B", "text": "Percutaneous biopsy", "correct": false}, {"label": "C", "text": "Observation with periodic imaging", "correct": true}, {"label": "D", "text": "Radiofrequency ablation", "correct": false}], "correct_answer": "C. Observation with periodic imaging", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/98qFpsSVyNw4nDwn70cs1739889513.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cUHwer6VFi0TFmG23fXZ1744895033.mp3", "video": ""}, {"text": "During a routine abdominal ultrasound of a 35-year-old female, a liver lesion was noted. imaging with a CECT scan shows a central stellate scar within the lesion. The patient is on oral contraceptive pills. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hepatocellular carcinoma", "correct": false}, {"label": "B", "text": "Focal nodular hyperplasia", "correct": true}, {"label": "C", "text": "Hepatic adenoma", "correct": false}, {"label": "D", "text": "Hemangioma", "correct": false}], "correct_answer": "B. Focal nodular hyperplasia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/igpbDP7eus4QnzC2Cnbv1739889913.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b5H44gcuE4a4EJ3Kayci1744895163.mp3", "video": ""}, {"text": "A 24-year-old woman presents with complaints of right upper quadrant abdominal pain for the past few weeks. She has a history of using oral contraceptive pills for the past 5 years. On examination, the physician palpates a slightly tender, smooth, and well-defined mass in the right upper quadrant. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hepatocellular carcinoma", "correct": false}, {"label": "B", "text": "Hepatic hemangioma", "correct": false}, {"label": "C", "text": "Hepatic adenoma", "correct": true}, {"label": "D", "text": "Focal nodular hyperplasia", "correct": false}], "correct_answer": "C. Hepatic adenoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3JCoZ99jT2rIt7p5Vu8n1744895314.mp3", "video": ""}, {"text": "In which of the following conditions are these CECT findings seen?", "options": [{"label": "A", "text": "Focal nodular hyperplasia", "correct": false}, {"label": "B", "text": "Serous cystadenoma of the pancreas", "correct": false}, {"label": "C", "text": "Renal oncocytoma", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": ["https://image.prepladder.com/content/uvmdbjcGUuj3zIgoLso61739890031.png"], "explanation_images": ["https://image.prepladder.com/content/muofR18kk4lMCUEOSl2M1739890115.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XwPLWHB7W9Y7RbHXlVxD1744895494.mp3", "video": ""}, {"text": "A 55-year-old male patient presents with persistent abdominal pain and unexplained weight loss He has a history of chronic hepatitis B infection and moderate alcohol consumption. Physical examination reveals mild jaundice and hepatomegaly. Which of the following risk factors is most strongly associated with developing hepatocellular carcinoma (HCC) in this patient?", "options": [{"label": "A", "text": "Age", "correct": false}, {"label": "B", "text": "Alcohol consumption", "correct": false}, {"label": "C", "text": "Hepatitis B infection", "correct": true}, {"label": "D", "text": "Male gender", "correct": false}], "correct_answer": "C. Hepatitis B infection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cirrhosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HBV infection</li>\n<li>HCV infection</li>\n<li>Alcohol</li>\n<li>NAFLD</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Chronic active hepatitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemochromatosis</li>\n<li>Wilson's Disease</li>\n<li>Glycogen Storage Disorder</li>\n<li>α1AT-deficiency</li>\n<li>Porphyria cutanea tarda</li>\n<li>Citrullinemia</li>\n<li>Orotic aciduria</li>\n<li>Alagille's syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cigarette Smoking</li>\n<li>Anabolic steroids</li>\n<li>Aflatoxin</li>\n<li>Thorotrast</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AHxRedQYPYJw7ifPpBgt1744895624.mp3", "video": ""}, {"text": "A 55-year-old man with a history of chronic hepatitis C and cirrhosis presents to the clinic with complaints of fatigue, unintentional weight loss, and abdominal discomfort. On physical examination, you note mild ascites and hepatomegaly. The serum alpha-fetoprotein level is elevated. What is the investigation of choice in this patient?", "options": [{"label": "A", "text": "MRI with MRCP", "correct": false}, {"label": "B", "text": "CECT", "correct": false}, {"label": "C", "text": "Triple phase CT", "correct": true}, {"label": "D", "text": "Liver biopsy", "correct": false}], "correct_answer": "C. Triple phase CT", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YEAmmNrf5pgclHzbCGbD1739890329.png", "https://image.prepladder.com/content/uCLTqsCox2zNfwMW6dce1739890409.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/j60xthCooGDEngbILQ2V1744895816.mp3", "video": ""}, {"text": "A 12-year-old boy presents with a history of fatigue, abdominal distension, and jaundice. He has a known diagnosis of liver cirrhosis secondary to chronic hepatitis B infection. Recently, he has developed a palpable liver mass, and imaging studies confirm the presence of hepatocellular carcinoma. Which of the following parameters is not typically used in the prognosis of his condition?", "options": [{"label": "A", "text": "Serum bilirubin", "correct": false}, {"label": "B", "text": "Serum ammonia", "correct": true}, {"label": "C", "text": "Serum albumin", "correct": false}, {"label": "D", "text": "Prothrombin time/INR", "correct": false}], "correct_answer": "B. Serum ammonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1 Point</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2 Points</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3 Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">Bilirubin</span> (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">Albumin</span> (g/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.8-3.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 2.8</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prothrombin Time/ INR </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 4</p>\n<p>&lt;1.7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-6</p>\n<p>1.7–2.2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 6</p>\n<p>&gt;2.2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate to Severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade 1-2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade 3-4</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/txa1UbicSUrxZzFofmU71744896047.mp3", "video": ""}, {"text": "A 65-year-old male with a history of chronic hepatitis B presents with increasing fatigue, weight loss, and right upper quadrant pain. Physical examination reveals jaundice and hepatomegaly. Imaging shows multiple lesions with a 4 cm mass in the right lobe and satellite nodules in the left lobe, along with portal vein thrombosis. His LFT shows elevated bilirubin and low albumin levels. The patient is diagnosed with HCC. According to standard protocol, what is the most appropriate treatment option for this patient?", "options": [{"label": "A", "text": "Surgical Resection", "correct": false}, {"label": "B", "text": "Liver Transplantation", "correct": false}, {"label": "C", "text": "Transarterial Chemoembolization (TACE)", "correct": false}, {"label": "D", "text": "Sorafenib", "correct": true}], "correct_answer": "D. Sorafenib", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ya4wWkKHEFxBSGqZxUMz1739890574.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:671px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage D</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very Early Stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early Stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate Stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Advanced Stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Terminal Stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Child-Pugh A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Child-Pugh A-B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Child-Pugh A-B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Child-Pugh A-B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Child-Pugh C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> &lt; 2 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> or 1-3 nodules, each &lt; 3 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multinodular HCC, no <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> invasion or <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> spread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> invasion, <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> spread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>End-stage liver disease or poor performance status</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical resection, Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> (if within Milan criteria)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> (if within Milan criteria), RFA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transarterial <span class=\"customMeta\" data-dictid=\"6d03d094f61692777184d2435362fe\">chemoembolization</span> (TACE)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic therapy (e.g., Sorafenib, Lenvatinib), <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">Palliative</span> care</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palliative care, Supportive care</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z12ZvO0SCGdmykjZOeJW1744896213.mp3", "video": ""}, {"text": "A 24-year-old female from Southeast Asia presents with abdominal pain and a palpable liver mass. She has no history of hepatitis B or C infection, and no signs of cirrhosis. Imaging studies show a well-circumscribed, non-encapsulated tumor in the liver with a central stellate scar. Laboratory tests reveal normal alpha-fetoprotein levels but elevated neurotensin and B12 binding globulin. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Scirrhous Variant of Hepatocellular Carcinoma", "correct": false}, {"label": "B", "text": "Fibrolamellar Variant of Hepatocellular Carcinoma", "correct": true}, {"label": "C", "text": "Cholangiocarcinoma", "correct": false}, {"label": "D", "text": "Metastatic Liver Cancer", "correct": false}], "correct_answer": "B. Fibrolamellar Variant of Hepatocellular Carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AGFVAyv2EHoCOCRttaFp1744896357.mp3", "video": ""}, {"text": "A 2-year-old male presents with an asymptomatic palpable abdominal mass detected during a routine physical examination. The child has a history of low birth weight and no history of hepatitis B or C infection. Laboratory tests reveal elevated alpha-fetoprotein levels. Imaging studies show a large intra-abdominal mass. Biopsy confirms hepatoblastoma. Which of the following statements about hepatoblastoma is incorrect?", "options": [{"label": "A", "text": "Hepatoblastoma is the most common primary malignancy of the liver in children.", "correct": false}, {"label": "B", "text": "The most common route of spread for hepatoblastoma is lymphatic.", "correct": true}, {"label": "C", "text": "Hepatoblastoma is not associated with Hepatitis B or C infection.", "correct": false}, {"label": "D", "text": "The most characteristic laboratory abnormality is thrombocytosis.", "correct": false}], "correct_answer": "B. The most common route of spread for hepatoblastoma is lymphatic.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The most common primary <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> of the liver in children</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most patients are less than 18 months old</li>\n<li>All patients are less than 3 years old</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">Adenomatous</span> Polyposis</li>\n<li>Beckwith-Wiedemann Syndrome</li>\n<li>Low Birth Weight (LBW)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Not associated with <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> B or C, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders, or cirrhosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> mass (hepatomegaly)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated alpha-fetoprotein level in 90% of patients</li>\n<li>Thrombocytosis <strong>(Most characteristic)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route of Spread; MC organ of metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hematogenous; Lungs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biopsy (Investigation of choice)</li>\n<li>CECT (Radiological Investigation of choice)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>No metastasis- </strong>Resection</li>\n<li><strong>Metastasis-</strong> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> + <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">Neoadjuvant</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (Vincristine, Cisplatin, 5-Fluorouracil)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UO3Mn76f829MWwOSMJuL1744896555.mp3", "video": ""}, {"text": "A 55-year-old male with a history of chronic liver disease secondary to hepatitis C presents for evaluation due to worsening ascites, jaundice, and weight loss. He has been diagnosed with hepatocellular carcinoma (HCC). Imaging reveals a single liver lesion measuring 4 cm in diameter with no evidence of vascular invasion or extrahepatic spread. Laboratory studies show stable liver function tests and AFP levels below 100 ng/mL. Which of the following criteria is the most critical in determining his eligibility for liver transplantation?", "options": [{"label": "A", "text": "Tumor size less than or equal to 5 cm", "correct": true}, {"label": "B", "text": "Absence of portal vein thrombosis", "correct": false}, {"label": "C", "text": "AFP (Alpha-fetoprotein) levels below 400 ng/mL", "correct": false}, {"label": "D", "text": "Platelet count greater than 100,000/µL", "correct": false}], "correct_answer": "A. Tumor size less than or equal to 5 cm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Size and Number</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Single tumor ≤ 5 cm in diameter</li>\n<li>Up to three tumors, each ≤ 3 cm in diameter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absence of <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No evidence of invasion of the major blood vessels by the tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">Extrahepatic</span> Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> or spread of the tumor outside the liver</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/R5OdfvtwNcVNlyeswkO81744896888.mp3", "video": ""}, {"text": "From the below given triple phase CT scan, which of the following statements is true regarding Liver cancer?", "options": [{"label": "A", "text": "Hypodense in arterial phase in HCC", "correct": false}, {"label": "B", "text": "Hyperdense in arterial phase in Metastasis liver disease", "correct": false}, {"label": "C", "text": "Hyperdense in non-contrast CT in HCC", "correct": false}, {"label": "D", "text": "Hypodense in venous phase in Metastasis liver disease", "correct": true}], "correct_answer": "D. Hypodense in venous phase in Metastasis liver disease", "question_images": ["https://image.prepladder.com/content/IExiri5Txy8c0H3AsZGY1739891039.png"], "explanation_images": ["https://image.prepladder.com/content/jGuS0YRmORjUKc06THj01739890831.png", "https://image.prepladder.com/content/bK6dvwEAXNF3mW3ps7Mb1739890899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Portal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed Phase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (HCC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypervascular with intense enhancement; <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> appears <span class=\"customMeta\" data-dictid=\"1dfb6906b91692777189e0acce4f86\">hyperdense</span> compared to surrounding liver.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Washout of contrast; <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> appears <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> (darker) compared to liver tissue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Further washout; <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> remains <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> or becomes <span class=\"customMeta\" data-dictid=\"7f06e594de1692777190bfb4be030b\">isodense</span> (similar density to liver).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypovascular <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> appear hypodense.</li>\n<li>Hypervascular <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> (e.g., <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumors) may show rim enhancement.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesions appear <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> and become more distinct.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesions remain hypodense, continuing to stand out from liver tissue.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/J3oPqeGbpWLzPZO5iN8P1744897156.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which type of pancreatic neoplasm most commonly arises in the tail of the pancreas?", "options": [{"label": "A", "text": "Serous cystadenoma.", "correct": false}, {"label": "B", "text": "Mucinous cystadenoma", "correct": false}, {"label": "C", "text": "VIPOMA", "correct": true}, {"label": "D", "text": "Adenocarcinoma pancreas", "correct": false}], "correct_answer": "C. VIPOMA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenocarcinoma <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> <strong> (Option D ruled out)</strong></li>\n<li>Serous cystadenoma<strong> (Option A ruled out)</strong></li>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> neoplasm</li>\n<li>Somatostatinoma</li>\n<li>PPOMA (Pancreatic <span class=\"customMeta\" data-dictid=\"287fd897ad1692777196f583338128\">Polypeptide</span> cell tumor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Body and tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glucagonoma</li>\n<li>Mucinous <span class=\"customMeta\" data-dictid=\"1289a1c47f1692777185c6c0e0b2b2\">cystadenoma</span> <strong> (Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>VIPOMA (Vasoactive intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> tumor) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution in body, head and tail.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insulinoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fdYKq6NlIKktmWAOHqjh1748792569.mp3", "video": ""}, {"text": "A 60-year-old male presents with recurrent episodes of abdominal pain and is found to have jaundice. An ERCP is performed, revealing thick mucus extruding through the ampulla of Vater. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pseudocyst", "correct": false}, {"label": "B", "text": "Main duct IPMN", "correct": true}, {"label": "C", "text": "Chronic pancreatitis", "correct": false}, {"label": "D", "text": "Pancreatic adenocarcinoma", "correct": false}], "correct_answer": "B. Main duct IPMN", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Btt8g8Q7p3s5NpSzOBrC1739879756.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uS84M65kQN8it4TaoW0R1748792244.mp3", "video": ""}, {"text": "What is the most common complication and common cause of death in a patient post pancreaticoduodenectomy?", "options": [{"label": "A", "text": "Delayed gastric emptying, Pulmonary complication", "correct": true}, {"label": "B", "text": "Anastomosis leak, Pulmonary complication", "correct": false}, {"label": "C", "text": "Delayed gastric emptying, Perforated bowel obstruction", "correct": false}, {"label": "D", "text": "Anastomosis leak, Perforated bowel obstruction", "correct": false}], "correct_answer": "A. Delayed gastric emptying, Pulmonary complication", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:294px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency (%)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreas fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intraabdominal abscess</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac events</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bile leak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overall reoperation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bAqmwcFJgvsO9GKLR8xl1748791080.mp3", "video": ""}, {"text": "A 48-year-old perimenopausal woman presents with abdominal discomfort. Imaging reveals a multilocular cyst with thick walls located in the pancreatic tail. Fine-needle aspiration of the cyst fluid shows high carcinoembryonic antigen levels exceeding 400 ng/mL, with normal amylase levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pancreatic pseudocyst", "correct": false}, {"label": "B", "text": "Serous cystadenoma", "correct": false}, {"label": "C", "text": "Mucinous cystic neoplasm", "correct": true}, {"label": "D", "text": "Adenoma of the Ampulla of Vater", "correct": false}], "correct_answer": "C. Mucinous cystic neoplasm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:677px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCNs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenomas</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudocysts </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous <span class=\"customMeta\" data-dictid=\"1289a1c47f1692777185c6c0e0b2b2\">cystadenoma</span> </strong><strong>(Option B ruled out)</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perimenopausal women</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varied</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of pancreatitis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older woman</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreatic body or tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ampulla of Vater</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anywhere in the pancreas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tail of pancreas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multilocular cysts, thick walls</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polypoid <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> masses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cysts with elevated amylase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lobular, <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with multiple small cysts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Tool</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CEA levels (&gt;400 ng/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History, imaging, <span class=\"customMeta\" data-dictid=\"ee24d3aa0016927771810af81a9cf3\">amylase</span> levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CECT: Central <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> scar, central sunburst calcification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/P2fuQKWcxASXGOaVB0Xt1748791886.mp3", "video": ""}, {"text": "A 45-year-old male has a history of recurrent peptic ulcers and severe abdominal pain. Despite the use of proton pump inhibitors, his symptoms persist. Endoscopic examination reveals small nodules in the medial wall of the duodenum. His family history is significant for multiple endocrine neoplasia type I. Which of the following statements is most likely true regarding his condition?", "options": [{"label": "A", "text": "The tumors are most commonly found in the tail of the pancreas.", "correct": false}, {"label": "B", "text": "The condition is curable with surgical removal of the primary tumor.", "correct": false}, {"label": "C", "text": "The patient's gastrinoma is likely located within the gastrinoma triangle.", "correct": true}, {"label": "D", "text": "The use of proton pump inhibitors has made diagnosis of this condition easier", "correct": false}], "correct_answer": "C. The patient's gastrinoma is likely located within the gastrinoma triangle.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duodenal loop, <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">Pancreas</span> (head) <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulceration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Historical Recognition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulcers unresponsive to surgery pre-PPI era. The use of <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump inhibitors has made the condition controllable but harder to recognize. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sporadic, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> (with <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> adenoma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common Locations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrinoma <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> (cystic duct/common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, duodenum, pancreas) <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small nodules in duodenal wall, <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> inspection needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Course</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indolent for some <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> gastrinomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palliative liver resection, liver transplantation, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal for palliation in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> as they are incurable. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Worse for tumors outside <span class=\"customMeta\" data-dictid=\"5cdc49fa8b1692777188e3f26ac676\">gastrinoma</span> triangle</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gfpve1K8dO6WbEla8eAy1747829650.mp3", "video": ""}, {"text": "A 70-year-old female patient is evaluated for a pancreatic cystic mass. The CT scan shows a lobular, hypodense lesion with multiple small cysts, a central hyperdense scar, and scattered \"sunburst\" calcifications. Based on these findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Mucinous cystic neoplasm", "correct": false}, {"label": "B", "text": "Pancreatic pseudocyst", "correct": false}, {"label": "C", "text": "Serous cystadenoma", "correct": true}, {"label": "D", "text": "Intraductal papillary mucinous neoplasm", "correct": false}], "correct_answer": "C. Serous cystadenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xwOhjPEWo2yjPyrRaLvE1739879421.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shape and Density</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lobular shape; <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> due to high water content.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in up to 30%; can show a \"<strong>sunburst</strong>\" pattern.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">Fibrous</span> Scar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperdense, <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> pattern, enhances with contrast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enhancement Patterns</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypervascular; <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> portions enhance post-contrast fluid density in less <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> areas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oligocystic and Macrocystic Variants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oligocystic patterns may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">mucinous</span> neoplasms; macrocystic variants may resemble pseudocysts or <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">mucinous</span> cysts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differentiation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Challenging to distinguish from other <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> pancreatic neoplasms; an <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be needed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aPjckIGcw6yC9Soz3Kht1748791768.mp3", "video": ""}, {"text": "What is the most common site of gastrinoma in patients with Zollinger–Ellison syndrome", "options": [{"label": "A", "text": "Stomach", "correct": false}, {"label": "B", "text": "Pancreas", "correct": false}, {"label": "C", "text": "Duodenum", "correct": true}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "C. Duodenum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jS3MzjRuyi81x4x72zdd1739879014.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fulminating <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> diathesis, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> ulceration, non-β <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> cell tumors (gastrinoma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incidence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>0.5-4 per million, 0.1% of duodenal ulcers, 20-25% associated with MEN</li>\n<li>Rarely occur in the stomach <strong>(Option A ruled out)</strong>, <span class=\"customMeta\" data-dictid=\"60f94bccfb169277719504d6185470\">peripancreatic</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, liver<strong> </strong><strong>(Option D ruled out)</strong>, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, ovary, and heart</li>\n<li>Pancreatic <span class=\"customMeta\" data-dictid=\"5cdc49fa8b1692777188e3f26ac676\">gastrinoma</span> comprises 25% of the cases <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sporadic (duodenum, small, multiple), <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1 (duodenum, <span class=\"customMeta\" data-dictid=\"5cdc49fa8b1692777188e3f26ac676\">gastrinoma</span> triangle)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptic ulcers, diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, high alcohol use history</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"2bc09ee1411692777203634e5cc443\">FSG</span> (fasting <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> gastrin), <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> pH &lt;2, <span class=\"customMeta\" data-dictid=\"1ff46c25d416927771987897f87843\">secretin</span> <span class=\"customMeta\" data-dictid=\"80806f031b1692777196a8db8c148e\">provocation</span> test, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1 screening, <span class=\"customMeta\" data-dictid=\"e485bb67f81692777191dfee6366cc\">localization</span> studies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery (sporadic without metastases, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1 &gt;2 cm)</p>\n<p>Medical (PPI, SSA, <span class=\"customMeta\" data-dictid=\"86fa60aecc1692777191a8e62c96ba\">locoregional</span> therapy)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/O9hiMegMKf73Cd2zQ1To1748791452.mp3", "video": ""}, {"text": "Among the following, which option correctly describes the most common location of origin of insulinoma in the pancreas?", "options": [{"label": "A", "text": "Head &amp;gt; Body &amp;gt; Tail", "correct": false}, {"label": "B", "text": "Body = Tail &amp;gt; Head", "correct": false}, {"label": "C", "text": "Tail &amp;gt; Body &amp;gt; Head", "correct": false}, {"label": "D", "text": "Head = Body = Tail", "correct": true}], "correct_answer": "D. Head = Body = Tail", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carcinoma pancreas</li>\n<li>Serous cystadenoma</li>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> neoplasm</li>\n<li>Somatostatinoma</li>\n<li>PPOMA (Pancreatic <span class=\"customMeta\" data-dictid=\"287fd897ad1692777196f583338128\">Polypeptide</span> cell tumor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Body and tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glucagonoma</li>\n<li>Mucinous cystadenoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>VIPOMA (Vasoactive Intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> tumor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution in body, head and tail. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insulinoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of pancreatic neoplasm most commonly arises in the body and tail of the pancreas?", "options": [{"label": "A", "text": "Serous cystadenom", "correct": false}, {"label": "B", "text": "Mucinous cystadenoma", "correct": true}, {"label": "C", "text": "Intraductal papillary mucinous neoplasm", "correct": false}, {"label": "D", "text": "Adenocarcinoma pancreas", "correct": false}], "correct_answer": "B. Mucinous cystadenoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenocarcinoma <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> <strong>(Option D ruled out)</strong></li>\n<li>Serous <span class=\"customMeta\" data-dictid=\"1289a1c47f1692777185c6c0e0b2b2\">cystadenoma</span> <strong>(Option A ruled out)</strong></li>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> <span class=\"customMeta\" data-dictid=\"1622f69a94169277719372b76236ca\">neoplasm</span> <strong>(Option C ruled out)</strong></li>\n<li>Somatostatinoma</li>\n<li>PPOMA (Pancreatic <span class=\"customMeta\" data-dictid=\"287fd897ad1692777196f583338128\">Polypeptide</span> cell tumor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Body and tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glucagonoma</li>\n<li>Mucinous <span class=\"customMeta\" data-dictid=\"1289a1c47f1692777185c6c0e0b2b2\">cystadenoma</span> <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>VIPOMA ( <span class=\"customMeta\" data-dictid=\"1059a0d9031692777201a8d8debd5e\">Vasoactive</span> intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> tumor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution in body, head and tail.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insulinoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/A5fJ7ZgR5Hx7jlSHzDCz1748792446.mp3", "video": ""}, {"text": "A 55-year-old male presents with jaundice, weight loss, and epigastric pain. Imaging reveals a mass in the head of the pancreas. Which of the following conditions is most likely responsible for these symptoms?", "options": [{"label": "A", "text": "Chronic Pancreatitis", "correct": false}, {"label": "B", "text": "Ductal Adenocarcinoma", "correct": true}, {"label": "C", "text": "Solid Pseudopapillary Neoplasm", "correct": false}, {"label": "D", "text": "Intraductal Papillary Mucinous Neoplasm", "correct": false}], "correct_answer": "B. Ductal Adenocarcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HG0IV08w0DnV3lW89yIT1748792341.mp3", "video": ""}, {"text": "A patient with a suspected intraductal papillary mucinous neoplasm (IPMN) has elevated serum CA 19-9 levels. What does this finding most likely suggest?", "options": [{"label": "A", "text": "The IPMN is benign and does not require surgical intervention", "correct": false}, {"label": "B", "text": "The IPMN is likely malignant or has high-grade dysplasia", "correct": true}, {"label": "C", "text": "The IPMN is a branch duct type and requires conservative management", "correct": false}, {"label": "D", "text": "The IPMN is likely malignant and surgery is contraindicated", "correct": false}], "correct_answer": "B. The IPMN is likely malignant or has high-grade dysplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Pathways</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Indications</strong>: Confirmed carcinoma/high-grade dysplasia, solid mass, jaundice, <span class=\"customMeta\" data-dictid=\"b61dc1c68d1692777193f8a6b8809b\">mural</span> nodules, significant <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> dilation.</p>\n<p><strong>Non-Surgical Management</strong>: For unsuitable candidates or non-surgical criteria, with regular monitoring (clinical, CA 19-9, imaging).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pylorus-Preserving <span class=\"customMeta\" data-dictid=\"68d86530641692777194d5ed7f2c23\">Pancreatoduodenectomy</span> (PPPD)</strong>: For pancreatic head tumors.</p>\n<p><strong>Distal Pancreatectomy</strong>: For body/tail tumors.</p>\n<p><strong>Total Pancreatectomy</strong>: For <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> tumors, unsafe <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> and whole <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> involvement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QdmicXcPUoI7mfSyNYro1748792125.mp3", "video": ""}, {"text": "In a patient with a pancreatic cyst, peripheral eggshell calcification on CT is:", "options": [{"label": "A", "text": "Common in benign cysts and easily detected.", "correct": false}, {"label": "B", "text": "Easily detected and a definitive marker of malignancy.", "correct": false}, {"label": "C", "text": "Difficult to detect but highly indicative of malignancy in mucinous cystic neoplasms.", "correct": true}, {"label": "D", "text": "Exclusively associated with pancreatic pseudocysts, not with malignancy.", "correct": false}], "correct_answer": "C. Difficult to detect but highly indicative of malignancy in mucinous cystic neoplasms.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YtlxLXzGlraiEtElmkNX1739879618.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:542px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcification Type</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peripheral eggshell <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging Modality</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CT scan (challenging to detect) <strong>(Options A &amp; B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predictive Value</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High for <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> <strong>(Option D ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typical Patient</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle-aged females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cyst Characteristics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilocular or <span class=\"customMeta\" data-dictid=\"8b7df3d24316927771937881a04879\">multilocular</span> macrocysts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thickened wall, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Action</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Further assessment and potential surgery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vk3semxBWh1gDGXn63ha1748791986.mp3", "video": ""}, {"text": "A 45-year-old patient presents with chronic watery diarrhea. Laboratory tests reveal elevated levels of vasoactive intestinal peptide (VIP) &amp;gt; 150 pg/ml, achlorhydria, and hypokalemia. Imaging studies show a solitary mass in the body of the pancreas. What is the treatment of choice in this condition?", "options": [{"label": "A", "text": "Initiate high-dose corticosteroid therapy with Prednisolone", "correct": false}, {"label": "B", "text": "Start treatment with Octreotide", "correct": false}, {"label": "C", "text": "Perform a distal pancreatectomy", "correct": true}, {"label": "D", "text": "Begin broad-spectrum antibiotic therapy", "correct": false}], "correct_answer": "C. Perform a distal pancreatectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uDPpZC0hAnd5SFRyYHMa1748791667.mp3", "video": ""}, {"text": "A 58-year-old female presents with diarrhea, weight loss, and itchy lesions around the mouth and vagina. Physical examination reveals a rash as shown in the image below. On evaluation, she has diabetes, and imaging studies indicate a large pancreatic mass. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Gastrinoma", "correct": false}, {"label": "B", "text": "Insulinoma", "correct": false}, {"label": "C", "text": "Glucagonoma", "correct": true}, {"label": "D", "text": "VIPoma", "correct": false}], "correct_answer": "C. Glucagonoma", "question_images": ["https://image.prepladder.com/content/Y8ewtA09XmHUDbhsDJoN1739879166.png"], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Aspect</strong></td>\n<td style=\"text-align:center\"><strong>Details</strong></td>\n</tr>\n<tr>\n<td><strong>Origin</strong></td>\n<td>Alpha cells of the pancreas</td>\n</tr>\n<tr>\n<td><strong>Common Locations</strong></td>\n<td>Body and tail of the pancreas</td>\n</tr>\n<tr>\n<td><strong>Size</strong></td>\n<td>5-10 cm</td>\n</tr>\n<tr>\n<td><strong>Prevalence</strong></td>\n<td>Sporadic; 17% with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> type II syndrome</td>\n</tr>\n<tr>\n<td><strong>Gender</strong></td>\n<td>More common in females</td>\n</tr>\n<tr>\n<td><strong>Malignancy</strong></td>\n<td>80% malignant; 80% spread to liver</td>\n</tr>\n<tr>\n<td><strong>Symptoms</strong></td>\n<td>Necrolytic <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> erythema, diabetes, diarrhea, weight loss, stomatitis, anemia, <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid deficiency, vulvovaginitis</td>\n</tr>\n<tr>\n<td><strong>Diagnostic Tests</strong></td>\n<td>MRI, CT scan, Endosonography, Angiogram, Serum <span class=\"customMeta\" data-dictid=\"c4d90ebfde1692777188e3689c1753\">glucagon</span> levels (&gt;50 pmol/L)</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>Anemia and <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> correction, IV <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids, DVT prevention, Distal pancreatectomy, Whipple’s/total pancreatectomy, Enucleation, Dacarbazine</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/w8zWnbuq0qMNI0y1n18d1745394761.mp3", "video": ""}, {"text": "A 45-year-old woman with a family history of cancer presents for a routine check-up. Her mother and maternal aunt both had pancreatic cancer. Genetic testing reveals a gain-of-function mutation in the PRSS1 gene. Which of the following factors contributes the most to her increased risk of developing pancreatic cancer?", "options": [{"label": "A", "text": "Chronic pancreatitis", "correct": false}, {"label": "B", "text": "Germline BRCA2 mutation", "correct": false}, {"label": "C", "text": "Lynch syndrome", "correct": false}, {"label": "D", "text": "Hereditary pancreatitis", "correct": true}], "correct_answer": "D. Hereditary pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Genetic Factor</strong></td>\n<td><strong>Relative Risk Increase</strong></td>\n</tr>\n<tr>\n<td>Family History (two first-degree relatives)</td>\n<td>18-57 times</td>\n</tr>\n<tr>\n<td>Germline BRCA2 Mutations</td>\n<td>High-risk families</td>\n</tr>\n<tr>\n<td>Hereditary Pancreatitis</td>\n<td>50-70 times</td>\n</tr>\n<tr>\n<td>Chronic Pancreatitis</td>\n<td>5-15 times</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sOAe49Sz5CEXiSWuIUBS1748790331.mp3", "video": ""}, {"text": "Which diagnostic finding is most indicative of an insulinoma?", "options": [{"label": "A", "text": "Elevated serum glucose levels", "correct": false}, {"label": "B", "text": "Low C-peptide levels", "correct": false}, {"label": "C", "text": "Elevated serum insulin levels during hypoglycemia", "correct": true}, {"label": "D", "text": "Hyperinsulinemic response to oral glucose tolerance test", "correct": false}], "correct_answer": "C. Elevated serum insulin levels during hypoglycemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:708px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p>A rare, typically<strong> <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumor of the pancreatic <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> cells</strong> that produces <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> insulin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p>Clinical Features</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p>Whipple's Triad-</p>\n<ul>\n<li>Documented low blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels during <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> episodes</li>\n<li>Relief of symptoms upon administration of glucose</li>\n<li>Symptoms often occur during <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> or after exercise</li>\n</ul>\n<p>Symptoms of <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> (e.g., sweating, palpitations, confusion, visual disturbances, seizures)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li><strong>Gold-standard test for diagnosing <span class=\"customMeta\" data-dictid=\"43b7327590169277719092c556b0b6\">insulinoma</span> is a 72-hour fast.</strong><strong> (Option C)</strong></li>\n<li>Combination of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt; 55 mg/dL + <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> level ≥ 3 microUnits/mL + <span class=\"customMeta\" data-dictid=\"c8c9de6f88169277718395f9b4def5\">C peptide</span> level ≥ to 0.6 ng/mL + <span class=\"customMeta\" data-dictid=\"dd9e08ae7c1692777196e4ee59fee9\">proinsulin</span> ≥ 5 pmol/L, + negative <span class=\"customMeta\" data-dictid=\"552023be76169277719976e36a990e\">sulfonylurea</span> level indicates that the <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> is by hyperinsulinemia</li>\n<li><strong>Insulin/glucose ratio &gt; 0.4 is <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> </strong></li>\n<li>Imaging:\n\t\t\t\t<ul>\n<li>CT, MRI, EUS</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:bottom\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is the treatment of choice</li>\n<li>Medical management with <span class=\"customMeta\" data-dictid=\"49eb173e4f1692777186d95adc7021\">diazoxide</span> or <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> for non-surgical candidates or unresectable tumors</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/46YBmZzgXI2CoFbnEQtP1748791307.mp3", "video": ""}, {"text": "Which of the following statements is true regarding neuroendocrine tumors of the pancreas?", "options": [{"label": "A", "text": "The most common non-functional neuroendocrine tumor of the pancreas is insulinoma", "correct": false}, {"label": "B", "text": "Somatostatin receptor scintigraphy is used for the localization of NETs", "correct": true}, {"label": "C", "text": "The most common site of metastasis is the lungs", "correct": false}, {"label": "D", "text": "Functional NETs are diagnosed at a later stage and have poor prognosis", "correct": false}], "correct_answer": "B. Somatostatin receptor scintigraphy is used for the localization of NETs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nq6zWcXeni4aCwwYRgeA1748791191.mp3", "video": ""}, {"text": "Which surgical procedure is characterized by the resection of the pancreatic head while preserving the stomach and pylorus?", "options": [{"label": "A", "text": "Whipple procedure", "correct": false}, {"label": "B", "text": "Distal pancreatectomy", "correct": false}, {"label": "C", "text": "Longmire Traverso procedure", "correct": true}, {"label": "D", "text": "Total pancreatectomy", "correct": false}], "correct_answer": "C. Longmire Traverso procedure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wlcIpKLyglvxHb54ZhLS1748790981.mp3", "video": ""}, {"text": "A patient is scheduled to undergo a Whipple procedure for the treatment of pancreatic cancer. The surgeon needs to perform anastomosis to reconstruct the digestive tract after removing the affected tissues. In which sequence are the anastomoses typically performed during a Whipple procedure?", "options": [{"label": "A", "text": "Hepaticojejunostomy → Pancreaticojejunostomy → Gastrojejunostomy", "correct": false}, {"label": "B", "text": "Pancreaticojejunostomy → Hepaticojejunostomy → Gastrojejunostomy", "correct": true}, {"label": "C", "text": "Gastrojejunostomy → Pancreaticojejunostomy → Hepaticojejunostomy", "correct": false}, {"label": "D", "text": "Pancreaticojejunostomy → Gastrojejunostomy → Hepaticojejunostomy", "correct": false}], "correct_answer": "B. Pancreaticojejunostomy → Hepaticojejunostomy → Gastrojejunostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QpcUrt8louERFt12JXfF1739878807.png", "https://image.prepladder.com/content/kqs1qdHL5Y23GYQNODVU1739878863.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Whipple’s procedure </strong> (Pancreaticoduodenectomy)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structures removed: Head of the pancreas, the first part of the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (duodenum), the gallbladder, and a portion of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</p>\n<p>Types:</p>\n<ul>\n<li>Pylorus-Preserving <span class=\"customMeta\" data-dictid=\"52a4f79cc91692777202cb70272b3c\">Whipple Procedure</span> (Preferred)</li>\n<li>Non–Pylorus-Preserving Whipple Procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pancreatic Cancer:</strong> Commonly treated with Whipple if cancer is <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the head of the pancreas.</li>\n<li><strong>Chronic Pancreatitis:</strong> when uncontrolled by medical management.</li>\n<li><strong>Tumors in Pancreas/Surrounding Areas:</strong> Includes duodenum, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, and <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure Steps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tumor Assessment: Explore <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to assess tumor size, location, and spread.</li>\n<li>Resection: Remove head of pancreas, duodenum, gallbladder, and part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct; this may include partial stomach resection.</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection: Remove and examine nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reconstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pancreaticojejunostomy:</strong> Connect remaining <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> to jejunum.</li>\n<li><strong>Hepaticojejunostomy:</strong> Connect common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> to jejunum.</li>\n<li><strong>Gastrojejunostomy:</strong> Connect stomach to jejunum.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Cancer Research UK\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Diagram_showing_the_parts_removed_with_a_Whipple%27s_operation_CRUK_337.svg\" data-tags=\"\" height=\"457\" src=\"https://image.prepladder.com/content/QpcUrt8louERFt12JXfF1739878807.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anastomosis Principles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tension-Free Connection:</strong> Achieve mucosa-to-mucosa connection for healing.</li>\n<li><strong>Order of Anastomoses: </strong>Pancreaticojejunostomy → <span class=\"customMeta\" data-dictid=\"db93ca9acc1692777188412df8a3d4\">Hepaticojejunostomy</span> → Gastrojejunostomy</li>\n<li><strong>Stent Placement: </strong>May use internal/external stents for small ducts.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Donato Gerardo Terrone, Luigi Lepanto, Jean-Sébastien Billiard, Damien Olivié, Jessica Murphy-Lavallée, Franck Vandenbroucke &amp; An Tang\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Illustration_of_Whipple_procedure.webp\" data-tags=\"\" height=\"480\" src=\"https://image.prepladder.com/content/kqs1qdHL5Y23GYQNODVU1739878863.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pancreatic Fistula: Major issue; managed with <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues.</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> Emptying</li>\n<li>Bleeding, wound infection</li>\n<li>Reoperation, increased mortality</li>\n<li>Dumping/Bile Reflux: Common after non-pylorus-preserving Whipple; pylorus-preserving method has uncertain benefits.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3RpEHVOnRmYcXbwT2QgJ1746104836.mp3", "video": ""}, {"text": "A 65-year-old male presents with jaundice, dark urine, and weight loss over the past two months. Courvoisier's Sign is positive on physical examination. What is the next best step in the management of this patient to both visualize pancreatic and biliary ducts, and tissue sampling?", "options": [{"label": "A", "text": "Computed Tomography", "correct": false}, {"label": "B", "text": "Endoscopic Ultrasonography", "correct": false}, {"label": "C", "text": "Endoscopic Retrograde Cholangiopancreatography", "correct": true}, {"label": "D", "text": "Diagnostic Laparoscopy", "correct": false}], "correct_answer": "C. Endoscopic Retrograde Cholangiopancreatography", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/V4sL8yjh13pFuXNQs6YM1738776020.png", "https://image.prepladder.com/content/bfjK2DhwqrocOCF9OE181738776115.png", "https://image.prepladder.com/content/ItEOZmsoxq6EcIVeY5MQ1738776165.png", "https://image.prepladder.com/content/V5qhjVTwyPUxVCM77zaM1738776259.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses and key features</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CT Scan</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First choice for diagnosing pancreatic cancer.</li>\n<li>Detects mass, <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> dilation, and pancreatic atrophy.</li>\n<li>Detection of metastasis.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Khaniya, Sudeep &amp; Koirala, Rabin &amp; Shakya, Vikal &amp; Adhikary, Shailesh &amp; Regmi, Rajendra &amp; Pandey, Sagar &amp; Agrawal, Chandra.\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Contrast-enhanced-CT-abdomen-showing-heterogeneous-lesion-in-the-head-and-uncinate_fig1_41806500\" data-tags=\"\" height=\"240\" src=\"https://image.prepladder.com/content/V4sL8yjh13pFuXNQs6YM1738776020.png\" width=\"400\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MRI/MRCP</p>\n<p>(Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> Cholangiopancreatography)</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complementary to CT for additional information.</li>\n<li>MRCP identifies <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and pancreatic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> issues.</li>\n<li>Does not show <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> visible on CT.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Magnetic_resonance_cholangiopancreatography#/media/File:MRCP_Choledocholithiasis.jpg\" data-tags=\"\" height=\"328\" src=\"https://image.prepladder.com/content/bfjK2DhwqrocOCF9OE181738776115.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ERCP</p>\n<p>(Endoscopic <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">Retrograde</span> Cholangiopancreatography)</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Visualizes pancreatic and <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> ducts.</strong></li>\n<li><strong>Allows for tissue sampling.</strong></li>\n<li>Key signs: Narrowing of ducts, double <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> sign.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"DrM!KEY\" data-hash=\"\" data-license=\"CC BY SA\" data-source=\"https://commons.wikimedia.org/wiki/File:ERCP_dilatation.png?uselang=en#Licensing\" data-tags=\"\" height=\"450\" src=\"https://image.prepladder.com/content/ItEOZmsoxq6EcIVeY5MQ1738776165.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>EUS</p>\n<p>(Endoscopic Ultrasound)</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Useful when CT does not show a tumor.</li>\n<li>Assesses <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> invasion and differentiates <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> tumors from pseudocyst</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Wee, Eric &amp; Lakhtakia, Sundeep &amp; Gupta, Rajesh &amp; Sekaran, Anuradha &amp; Shetty, Mahesh &amp; Kalapala, Rakesh &amp; Monga, Amitabh &amp; Saravanan, Arjunan &amp; Re, Pradeep &amp; Ramchandani, Mohan &amp; Rao, Guduru &amp; Reddy, Duvvuru.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Ampullary-tumor-T-as-seen-with-a-radial-echoendoscope-positioned-in-the-duodenal-bulb_fig2_230894559\" data-tags=\"\" height=\"440\" src=\"https://image.prepladder.com/content/V5qhjVTwyPUxVCM77zaM1738776259.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/imECM488DfioYsS7N1d61748790757.mp3", "video": ""}, {"text": "A 55-year-old man with no history of obesity or a family history of diabetes is recently diagnosed with diabetes mellitus. He also reports vague upper abdominal discomfort, significant weight loss, and mild jaundice. Which of the following findings on physical examination would most likely suggest a diagnosis of pancreatic cancer?", "options": [{"label": "A", "text": "Tender and enlarged gallbladder", "correct": false}, {"label": "B", "text": "Hepatomegaly with jaundice", "correct": false}, {"label": "C", "text": "Courvoisier's sign", "correct": true}, {"label": "D", "text": "Murphy’s sign", "correct": false}], "correct_answer": "C. Courvoisier's sign", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/61qp9lRI5IfhoZbD793W1748790582.mp3", "video": ""}, {"text": "A 56-year-old patient with pancreatic cancer has completed initial treatment. To monitor for potential recurrence, the oncologist decides to check a tumor marker. Which of the following tumor markers is commonly used for establishing a baseline and monitoring for recurrence in pancreatic cancer?", "options": [{"label": "A", "text": "Alpha-fetoprotein", "correct": false}, {"label": "B", "text": "Carbohydrate Antigen 19-9", "correct": true}, {"label": "C", "text": "Carcinoembryonic Antigen", "correct": false}, {"label": "D", "text": "Human Chorionic Gonadotropin", "correct": false}], "correct_answer": "B. Carbohydrate Antigen 19-9", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/B9HPejuQCaHJTADYdstY1748790445.mp3", "video": ""}, {"text": "A 65-year-old man presents with symptoms of jaundice and abdominal pain. Imaging studies reveal a solid mass in the pancreatic head. Histological examination shows a dense fibrous stroma with neoplastic tubular glands. The tumor is characterized by local spread along nerves, lymphatics, and blood vessels, and has metastasized to the liver. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Serous cystadenoma", "correct": false}, {"label": "B", "text": "Mucinous cystic neoplasm", "correct": false}, {"label": "C", "text": "Ductal adenocarcinoma", "correct": true}, {"label": "D", "text": "Solid pseudopapillary neoplasm", "correct": false}], "correct_answer": "C. Ductal adenocarcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typical Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ductal Adenocarcinoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Solid tumors with <span class=\"customMeta\" data-dictid=\"c82360aadd16927771936d67fa30a4\">neoplastic</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> glands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreas (general)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serous Cystadenomas <strong>(Option A ruled put)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large clusters of small cysts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older women</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucinous <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> Neoplasms</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thick-walled, <span class=\"customMeta\" data-dictid=\"8b7df3d24316927771937881a04879\">multilocular</span> cysts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreatic body or tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perimenopausal women</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intraductal <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> Neoplasms (IPMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multifocal, more likely malignant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreatic head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older men</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Solid <span class=\"customMeta\" data-dictid=\"d625c104cc1692777196f5e31e17ae\">Pseudopapillary</span> Neoplasms <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large, partially solid, partially <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> masses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Women of childbearing age</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adenomas of the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">Ampulla</span> of Vater</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth, <span class=\"customMeta\" data-dictid=\"a3c898fa9e1692777196b39e3bf93c\">polypoid</span> <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> masses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ampulla of Vater</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ampullary Adenocarcinomas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early presentation with <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ampulla of Vater</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MyYeaQj86Hnrr8HATlhw1747151806.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old female who recently underwent bone marrow transplantation presents with abdominal pain and swelling. The clinical features resonate with hepatic veno-occlusive disease and a transvenous hepatic biopsy confirms the diagnosis. Which of the following symptoms is NOT a part of the clinical triad of hepatic veno-occlusive disease?", "options": [{"label": "A", "text": "Tender hepatomegaly", "correct": false}, {"label": "B", "text": "Hyperbilirubinemia (jaundice)", "correct": false}, {"label": "C", "text": "Retention of fluid (ascites)", "correct": false}, {"label": "D", "text": "Portal hypertension", "correct": true}], "correct_answer": "D. Portal hypertension", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> caused by endothelial <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> of <span class=\"customMeta\" data-dictid=\"bce6a4863a1692777199d020c31df4\">sublobular</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> veins and venules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>The most common cause in Western countries:</strong> <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">Bone marrow</span> transplantation</li>\n<li><strong>Chemotherapy agents:</strong> Cytarabine, Thioguanine, Gemtuzumab, Ozogamicin</li>\n<li><strong>Immunosuppressive agents:</strong> Azathioprine</li>\n<li><strong>Consumption of bush teas:</strong> <span class=\"customMeta\" data-dictid=\"6de8e14b321692777185737c5a72ad\">Crotalaria</span> and <span class=\"customMeta\" data-dictid=\"1d330db16c1692777198c2af01de29\">Senecio</span> (contain <span class=\"customMeta\" data-dictid=\"f07830b2ef16927771961be1ed141e\">pyrrolizidine</span> alkaloids)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features (Triad)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tender hepatomegaly</li>\n<li>Hyperbilirubinemia (jaundice)</li>\n<li>Retention of fluid (ascites)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of choice:</strong> Biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>SSPCS (Side-to-side portocaval shunt):</strong> Only if <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> sparing</li>\n<li><strong>Liver transplantation:</strong> For <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure</li>\n<li><strong>Defibrotide:</strong> Improves survival</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hkAyxLHFSUWNrheitD8S1744899723.mp3", "video": ""}, {"text": "Which of the following is a pre-sinusoidal cause of portal hypertension?", "options": [{"label": "A", "text": "Cirrhosis", "correct": false}, {"label": "B", "text": "Budd-Chiari syndrome", "correct": false}, {"label": "C", "text": "Congestive cardiac failure", "correct": false}, {"label": "D", "text": "Schistosomiasis", "correct": true}], "correct_answer": "D. Schistosomiasis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:544px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pre-sinusoidal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinusoidal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-sinusoidal</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extrahepatic</strong></p>\n<ul>\n<li>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Myelofibrosis</li>\n<li>Arterioportal shunt</li>\n<li>Tropical splenomegaly</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Intrahepatic</strong></p>\n<ul>\n<li><strong>Schistosomiasis</strong></li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> fibrosis</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> (e.g., sarcoidosis)</li>\n<li>Drugs and toxins</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cirrhosis</strong></li>\n</ul>\n<p><strong>(Option A)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> (<strong>Budd-Chiari syndrome</strong>)</li>\n<li>Veno-occlusive disease</li>\n<li><strong>Congestive <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure</strong></li>\n</ul>\n<p><strong>(Option B and C)</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/75Ecg7joIjKue8I8DjDS1744898144.mp3", "video": ""}, {"text": "A 52-year-old man presents to the emergency department with worsening abdominal distension and visible abdominal veins. He has a history of chronic alcohol abuse and has been experiencing increasing fatigue and jaundice. Which of the following vessels is involved in this condition?", "options": [{"label": "A", "text": "Left gastric vein", "correct": false}, {"label": "B", "text": "Superior and inferior epigastric vein", "correct": true}, {"label": "C", "text": "Superior mesenteric vein", "correct": false}, {"label": "D", "text": "Inferior vena cava", "correct": false}], "correct_answer": "B. Superior and inferior epigastric vein", "question_images": ["https://image.prepladder.com/content/PCZ7NrSIOEtCjv5kf7Li1739940051.png"], "explanation_images": ["https://image.prepladder.com/content/uvkxa4QR7iEfid2uN9321739940210.png", "https://image.prepladder.com/content/8MF5HK0QwJP4zUreCZsh1739940247.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eclwhTrgcycyGn9Qi5uD1744898278.mp3", "video": ""}, {"text": "A 55-year-old man with a history of cirrhosis presents to the emergency department with hematemesis and melena. He is hypotensive and tachycardic. Which of the following is the most appropriate initial step in management?", "options": [{"label": "A", "text": "Order an urgent upper endoscopy", "correct": false}, {"label": "B", "text": "Administer a proton pump inhibitor", "correct": false}, {"label": "C", "text": "Request a CT scan of the abdomen", "correct": false}, {"label": "D", "text": "Initiate fluid resuscitation", "correct": true}], "correct_answer": "D. Initiate fluid resuscitation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/alnzdcAjnKUdgL69orGE1739940313.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sSRg0UmYGxI5rH4Do4Kh1744898420.mp3", "video": ""}, {"text": "Which of the following statements is true about the image below?", "options": [{"label": "A", "text": "Technically difficult to perform", "correct": false}, {"label": "B", "text": "Decreased chances of perforation", "correct": false}, {"label": "C", "text": "Always preferred over ligation", "correct": false}, {"label": "D", "text": "Lack of depth perception is present", "correct": true}], "correct_answer": "D. Lack of depth perception is present", "question_images": ["https://image.prepladder.com/content/kLka4Mkgd4ADuzvA0fSQ1739940352.png"], "explanation_images": ["https://image.prepladder.com/content/QRh1MxnsNXFduiJ8OYnj1739940401.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NM7IqTJP2jnqM44071k81744898616.mp3", "video": ""}, {"text": "Identify the tube shown in the following image used in the management of portal hypertension.", "options": [{"label": "A", "text": "Sengstaken-Blakemore tube", "correct": true}, {"label": "B", "text": "Minnesota tube", "correct": false}, {"label": "C", "text": "Linton-Nachlas tube", "correct": false}, {"label": "D", "text": "Nasogastric (Ryle's) tube", "correct": false}], "correct_answer": "A. Sengstaken-Blakemore tube", "question_images": ["https://image.prepladder.com/content/J6gAA5FX6x4pJLyJCdhV1739940439.png"], "explanation_images": ["https://image.prepladder.com/content/lahj2xXengxXObLEtDBJ1739940483.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oUlYnS0Ey5oJ7IyAtCDj1744898834.mp3", "video": ""}, {"text": "A 60-year-old patient with refractory ascites secondary to cirrhosis undergoes Transjugular intrahepatic portosystemic shunt placement. Two days post-procedure, the patient develops severe dyspnea, peripheral edema, jugular venous distension, and hypotension. A Doppler ultrasound reveals a patent shunt. Which of the following is the most likely cause of the patient's symptoms?", "options": [{"label": "A", "text": "Right heart failure", "correct": true}, {"label": "B", "text": "Hepatorenal syndrome", "correct": false}, {"label": "C", "text": "Pulmonary hypertension", "correct": false}, {"label": "D", "text": "Porto-pulmonary hypertension", "correct": false}], "correct_answer": "A. Right heart failure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/X5G2Z5K7IsDyXcCiLTgv1739940545.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Variceal bleeding</li>\n<li>Refractory ascites</li>\n<li>Hepatic hydrothorax</li>\n<li>Budd Chiari Syndrome</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">Hypertensive</span> gastropathy</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy</li>\n<li>Severe heart failure</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</li>\n<li>Uncontrolled <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infection</li>\n<li>Polycystic liver disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jUHWVwJ6SBphQPF33ZFL1744898994.mp3", "video": ""}, {"text": "Which of the following complications is most likely to occur after the creation of a side-to-side portocaval shunt (SSPCS)?", "options": [{"label": "A", "text": "Encephalopathy", "correct": true}, {"label": "B", "text": "Renal failure", "correct": false}, {"label": "C", "text": "Recurrent variceal bleeding", "correct": false}, {"label": "D", "text": "Portal vein thrombosis", "correct": false}], "correct_answer": "A. Encephalopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cQgKlSI6fjaVm9WSDJj91739940633.png", "https://image.prepladder.com/content/Ty7uhJDRGCpTSkQz20wP1739940681.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sK9FNosR6NuGVoliKEqM1744899121.mp3", "video": ""}, {"text": "Which selective shunt procedure is associated with the preservation of portal perfusion to the liver while effectively decompressing varices?", "options": [{"label": "A", "text": "Distal splenorenal shunt (DSRS)", "correct": true}, {"label": "B", "text": "Proximal splenorenal shunt (PSRS)", "correct": false}, {"label": "C", "text": "Side-to-side portocaval shunt (SSPCS)", "correct": false}, {"label": "D", "text": "Interposition grafts", "correct": false}], "correct_answer": "A. Distal splenorenal shunt (DSRS)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p1HKlo4p0fWWD7fboeHi1739940967.png", "https://image.prepladder.com/content/iIRjC9fD4WQISsEp5lKG1739941017.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rqeKdcNXQplGLczPT2aG1744899256.mp3", "video": ""}, {"text": "In a patient with Budd Chiari Syndrome, which of the following imaging findings is most indicative of chronic disease?", "options": [{"label": "A", "text": "Enlarged caudate lobe", "correct": true}, {"label": "B", "text": "Ascites", "correct": false}, {"label": "C", "text": "Hepatic vein thrombosis", "correct": false}, {"label": "D", "text": "Splenomegaly", "correct": false}], "correct_answer": "A. Enlarged caudate lobe", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GibAQwOXcfNGDI0q5rzm1739941122.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dcLWnDrTjUveiGB8ipVn1744899367.mp3", "video": ""}, {"text": "A 12-year-old boy presents with a history of recurrent episodes of gastrointestinal bleeding. He has no history of liver disease, jaundice, or ascites. Physical examination reveals moderate splenomegaly but no hepatomegaly. Doppler ultrasound of the abdomen shows obstruction at the confluence of the splenic vein and the superior mesenteric vein. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cirrhosis", "correct": false}, {"label": "B", "text": "Non-Cirrhotic Portal Fibrosis (NCPF)", "correct": false}, {"label": "C", "text": "Extrahepatic Portal Vein Obstruction (EHPVO)", "correct": true}, {"label": "D", "text": "Budd-Chiari Syndrome", "correct": false}], "correct_answer": "C. Extrahepatic Portal Vein Obstruction (EHPVO)", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xlaEiWHmzI3Ka8yf6HBd1744899559.mp3", "video": ""}, {"text": "A 45-year-old man presents to the emergency department with a 3-day history of left upper quadrant abdominal pain and nausea. He has a history of chronic pancreatitis due to alcohol abuse. Physical examination reveals tenderness in the left upper quadrant and splenomegaly. Abdominal CT scan without contrast shows a thrombus in the splenic vein. What type of varices are likely to be seen on endoscopic examination?", "options": [{"label": "A", "text": "Esophageal varices", "correct": false}, {"label": "B", "text": "Gastric varices", "correct": true}, {"label": "C", "text": "Esophageal and gastric varices, with esophageal predominant", "correct": false}, {"label": "D", "text": "Duodenal varices", "correct": false}], "correct_answer": "B. Gastric varices", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pancreatic disorders <strong>(most common)</strong>:</li>\n</ul>\n<ul>\n<li>Acute or chronic pancreatitis</li>\n<li>Pancreatic cancer</li>\n</ul>\n<ul>\n<li>Abdominal trauma or surgery</li>\n<li>Hypercoagulable states</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstruction of splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> leading to increased pressure in splenic circulation</li>\n<li>Development of <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> (left-sided <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension)</li>\n<li>Formation of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> (<strong>predominantly</strong>) and <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> varices</li>\n<li>Splenomegaly due to congestion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> showing splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> occlusion</li>\n<li>Endoscopic ultrasound</li>\n<li>Angiography (less commonly used)</li>\n<li><strong>Clinical signs</strong>: splenomegaly, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> varices, normal liver function</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treat underlying cause (e.g., pancreatitis)</li>\n<li>Anticoagulant therapy using LMWH</li>\n<li>Splenectomy for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients or those with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> varices</li>\n<li>Endoscopic management of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> varices</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0RLtHsLnzraNHUfInIwk1744899833.mp3", "video": ""}, {"text": "A 60-year-old male with a history of cirrhosis presents with recurrent esophageal variceal bleeding that has not responded to endoscopic treatments. The patient is scheduled for a Sugiura procedure. Which of the following components is NOT part of the Sugiura procedure?", "options": [{"label": "A", "text": "Splenectomy", "correct": false}, {"label": "B", "text": "Esophagogastric devascularization", "correct": false}, {"label": "C", "text": "Intraesophageal portacaval shunt", "correct": true}, {"label": "D", "text": "Esophageal transection", "correct": false}], "correct_answer": "C. Intraesophageal portacaval shunt", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u2pmYnUimddLi94QjfjC1739941179.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GTf3jpnQvHFd86zLrSZH1744899940.mp3", "video": ""}, {"text": "A 48-year-old male is diagnosed with portal hypertension. Hepatic venous pressure gradient (HVPG) measurements are taken to assess the severity of his portal hypertension. Based on the prognostic values of HVPG, what are the cut-off HVPG values for clinically significant portal hypertension and increased risk of acute variceal bleeding respectively?", "options": [{"label": "A", "text": "≥6 mm Hg, ≥10mm Hg", "correct": false}, {"label": "B", "text": "≥8 mm Hg, ≥12 mm Hg", "correct": false}, {"label": "C", "text": "≥10 mm Hg, ≥12 mm Hg", "correct": true}, {"label": "D", "text": "≥16 mm Hg, ≥18 mm Hg", "correct": false}], "correct_answer": "C. ≥10 mm Hg, ≥12 mm Hg", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HVPG-Values</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-5 mm Hg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-10 mm Hg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preclinical <span class=\"customMeta\" data-dictid=\"00e480945216927771982870470f92\">sinusoidal</span> <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥10 mm Hg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinically significant <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥12 mm Hg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk for <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of varices</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥16 mm Hg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk of mortality</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥20 mm Hg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment failure and mortality in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"d4607865bb1692777201a35341db81\">variceal</span> bleeding</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zOFgjk2fOuvUKfTFtR8M1744900039.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient underwent cholecystectomy for gallstones 2.5 years ago. She now presents with symptoms of obstructive jaundice. Investigation reveals a stone in the common bile duct. What is the stone most likely to be?", "options": [{"label": "A", "text": "Primary", "correct": false}, {"label": "B", "text": "Secondary", "correct": false}, {"label": "C", "text": "Tertiary", "correct": false}, {"label": "D", "text": "Recurrent", "correct": true}], "correct_answer": "D. Recurrent", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BvKG7MMRIjOK7w8XBip51746449567.png", "https://image.prepladder.com/content/rXBrSHbDbLrKj1BGQpWI1745472702.png", "https://image.prepladder.com/content/MAPA9k80DGqPBr4c4bA81745472702.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Retained common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> stones</strong>\n<ul>\n<li>Detected within 2 years of cholecystectomy</li>\n</ul>\n</li>\n<li><strong>Recurrent common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> stones</strong>\n<ul>\n<li>Detected after 2 years of <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> <strong>(Option D)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Charcot’s <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> : </strong>Pain + Fever + Jaundice</li>\n<li><strong>Reynauld’s pentad:</strong> Mental status changes + Hypotension + Charcot’s triad</li>\n<li><strong>Biliary colic:</strong> A sudden, severe, colicky pain in the right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> that radiates to the back and shoulder, precipitated by a <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> or heavy meal, and can last for a few hours.</li>\n<li>Darkening of the <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and <span class=\"customMeta\" data-dictid=\"1b795394751692777191dd8d839fe7\">lightening</span> of the stools.</li>\n<li>Steatorrhea, or <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> stools</li>\n<li>Pruritus (itching), loss of appetite, weight loss, nausea, and vomiting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound:</strong> Useful for detecting gallstones and CBD <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> but has limited sensitivity for CBD stones.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"CBD -USG\" data-author=\"Cerevisae\" data-hash=\"12041\" data-license=\"CC BY-SA 4.0\" data-source=\"File:Ultrasound of stone within the distal common bile duct.jpg - Wikimedia Commons\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/BvKG7MMRIjOK7w8XBip51746449567.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>MRCP:</strong> Non-invasive, excellent for visualising <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and pathology.</li>\n<li><strong>ERCP:</strong> Highly sensitive, both <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> for CBD stones.</li>\n<li><strong>PTC:</strong> Used when ERCP is not feasible, such as post-gastrectomy patients or unsuccessful ERCP attempts.</li>\n<li><strong>EUS:</strong> <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> but accurate for diagnosing choledocholithiasis.</li>\n<li><strong>Blood Tests:</strong> ↑ bilirubin, ↑alkaline phosphatase, and ↑white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> indicate <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and possible complications like cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Endoscopic Management:</strong> ERCP with <span class=\"customMeta\" data-dictid=\"175e83e48b1692777199af3924b28b\">sphincterotomy</span> and stone extraction; stenting if necessary.</li>\n<li><strong>Percutaneous Removal:</strong> Used when <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> access is difficult.</li>\n<li><strong>Surgery:</strong> Options include <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> and open choledocholithotomy, choledochoduodenostomy, and choledochojejunostomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cholangitis</li>\n<li>Pancreatitis</li>\n<li>Liver Damage</li>\n<li>Biliary Stricture</li>\n<li>Gallstone Ileus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following procedure is performed for the management of?", "options": [{"label": "A", "text": "Advanced gastric carcinoma", "correct": false}, {"label": "B", "text": "Gallbladder carcinoma", "correct": false}, {"label": "C", "text": "Distal cholangiocarinoma", "correct": true}, {"label": "D", "text": "Chronic calcific pancreatitis", "correct": false}], "correct_answer": "C. Distal cholangiocarinoma", "question_images": ["https://image.prepladder.com/notes/wTOInHJohjciOpsiWmQm1746704468.png"], "explanation_images": ["https://image.prepladder.com/notes/41Sr9IcpKitk1iGZZOE51745336558.jpg", "https://image.prepladder.com/notes/TbvysQfN5aWK0PvZFOMf1745337176.jpg"], "explanation": "<table cellpadding=\"0\" cellspacing=\"0\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<p>Structures removed: Head of the pancreas, the first part of the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (duodenum), the gallbladder, and a portion of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</p>\n<p>Types:</p>\n<p>• Pylorus-Preserving Whipple Procedure</p>\n<p>• Non–Pylorus-Preserving Whipple Procedure</p>\n</td>\n<td style=\"vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Pancreatic Cancer:</strong> Commonly treated with Whipple if cancer is localised to the head of the pancreas. </p>\n<p><strong>Chronic Pancreatitis:</strong> when uncontrolled by medical management. </p>\n<p><strong>Tumors in Pancreas/Surrounding Areas:</strong> Includes duodenum, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (distal cholangiocarcinoma), and <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Procedure Steps</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Tumor Assessment:</strong> Explore the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to assess tumor size, location, and spread. </p>\n<p><strong>Resection:</strong> Remove the head of the pancreas, duodenum, gallbladder, and part of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct; this may include partial stomach resection. </p>\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection:</strong> Remove and examine nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n<figure class=\"caption_element\"><img alt=\"Whipple's procedure\" data-author=\"Cancer Research UK\" data-hash=\"11027\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Diagram_showing_the_parts_removed_with_a_Whipple%27s_operation_CRUK_337.svg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/41Sr9IcpKitk1iGZZOE51745336558.jpg\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Reconstruction</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Pancreaticojejunostomy:</strong> Connect the remaining <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> to the jejunum. <strong>Hepaticojejunostomy:</strong> Connect common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> to the jejunum. <strong>Gastrojejunostomy:</strong> Connect stomach to jejunum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Anastomosis Principles</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Tension-Free Connection:</strong> Achieve mucosa-to-mucosa connection for healing. </p>\n<p><strong>Order of Anastomoses: </strong>Pancreaticojejunostomy → Hepaticojejunostomy → Gastrojejunostomy</p>\n<p><strong>Stent Placement: </strong>May use internal/external stents for small ducts.</p>\n<figure class=\"caption_element\"><img alt=\"Pylorus Preserving Whipple’s Procedure anastomoses\" data-author=\"Donato Gerardo Terrone, Luigi Lepanto, Jean-Sébastien Billiard, Damien Olivié, Jessica Murphy-Lavallée, Franck Vandenbroucke &amp; An Tang\" data-hash=\"11041\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Illustration_of_Whipple_procedure.webp\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/TbvysQfN5aWK0PvZFOMf1745337176.jpg\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p>• Pancreatic Fistula: Major issue; managed with <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues. </p>\n<p>• Delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> Emptying</p>\n<p>• Bleeding, wound infection</p>\n<p>• Reoperation, increased mortality </p>\n<p>• Dumping/Bile Reflux: Common after non-pylorus-preserving Whipple, the pylorus-preserving method has uncertain benefits.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent laparoscopic cholecystectomy and was discharged after removing the drain tube on the first postoperative day. On day two, the patient came back to the hospital with complaints of increasing abdominal pain with tachycardia and was febrile on examination. On ultrasound examination, there was a 5 x 5 cm collection in the subhepatic space. What is the most likely cause of this condition?", "options": [{"label": "A", "text": "Infection", "correct": false}, {"label": "B", "text": "Surgical site pain", "correct": false}, {"label": "C", "text": "Bile leak", "correct": true}, {"label": "D", "text": "Retained gallstones", "correct": false}], "correct_answer": "C. Bile leak", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\"&gt;Bile&lt;/span&gt; leak\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your approach in managing a patient who is a 40-year-old woman with a 5 mm gallbladder polyp detected on abdominal ultrasound, but no gallbladder stones? The patient is overall healthy and shows no symptoms.", "options": [{"label": "A", "text": "Regular follow-up every 2 months", "correct": true}, {"label": "B", "text": "Polypectomy", "correct": false}, {"label": "C", "text": "Laparoscopic cholecystectomy", "correct": false}, {"label": "D", "text": "Open cholecystectomy", "correct": false}], "correct_answer": "A. Regular follow-up every 2 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Regular follow-up every 2 months:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Polyp Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;6 mm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular follow-up (USG every 6–12 months for 2 years)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6–9 mm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follow-up every <strong>3–6 months</strong>, consider <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> if growth or risk factors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>≥10 mm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic cholecystectomy</strong> (higher <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Any size + symptoms or high-risk features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic cholecystectomy</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common side effect of cholecystectomy?", "options": [{"label": "A", "text": "Acute kidney injury", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": false}, {"label": "C", "text": "Steatorrhea", "correct": true}, {"label": "D", "text": "Colorectal cancer", "correct": false}], "correct_answer": "C. Steatorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Steatorrhea</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description/Features</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early (Intraoperative &amp; Immediate Postoperative)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accidental damage to the <strong>common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CBD)</strong> leads to <strong>bile leakage or strictures</strong> (More common in <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding from the <strong>cystic artery</strong> or liver bed; managed with <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">hemostasis</span> or blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> if severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unintended injury to the <strong>duodenum or colon</strong>, is rare but serious.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anesthesia-related Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspiration, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression, hypotension</strong>, and arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">Postoperative</span> (0–7 Days)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infection (Wound/Port-Site Abscess)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever, erythema, tenderness</strong> at the <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> site. More common in <strong>diabetics</strong> or <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bile Leak (Biloma)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, nausea</strong>, and <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <strong>fluid collection</strong> on imaging. Often from <strong>cystic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> or <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subhepatic Collection (Abscess)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever, RUQ pain, and tachycardia</strong>; requires <strong>percutaneous drainage</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retained Gallstones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Residual gallstones in the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</strong> can cause <strong>biliary colic or cholangitis</strong> postoperatively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">Thrombosis</span> (DVT) &amp; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <strong>prolonged immobilization</strong>, leading to leg <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or <strong>sudden dyspnea</strong> (Prevent with early ambulation, anticoagulation).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">Postoperative</span> (&gt;7 Days – Months/Years)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steatorrhea (Fatty Stools)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common long-term issue</strong> due to <strong>continuous <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> secretion</strong>, leading to <strong>fat malabsorption</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Cholecystectomy Syndrome (PCS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Persistent dyspepsia, bloating, diarrhea, or RUQ pain</strong> due to <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> or <span class=\"customMeta\" data-dictid=\"bead1cecfa16927771979940742ada\">remnant</span> stones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biliary Strictures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic narrowing of the <strong>CBD</strong>, leading to <strong>jaundice and cholangitis</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Diarrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Related to <strong>altered <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid metabolism</strong>, may require <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid sequestrants (e.g., cholestyramine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Risk of <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">Colorectal</span> Cancer (Debatable)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Some studies suggest a mild <strong>increase in <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer risk</strong> due to <strong>altered <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid metabolism</strong>, but <strong>evidence is weak</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man presents to the emergency department with complaints of severe abdominal pain and 3 episodes of vomiting in the past 9 hours. He says that the pain radiates to the back and is partially relieved by bending forwards. The abdominal radiograph of the patient is given below which shows a ‘colon cut-off sign ’. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute hepatitis", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute colitis", "correct": false}, {"label": "D", "text": "Intestinal obstruction", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; pancreatitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <strong>premature <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> activation</strong>, leads to autodigestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong> (<em>Mnemonic: \"I GET SMASHED\"</em>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong>diopathic, <strong>G</strong>allstones (most common), <strong>E</strong>thanol, <strong>T</strong>rauma, <strong>S</strong>teroids, <strong>M</strong>umps, <strong>A</strong>utoimmune, <strong>S</strong>corpion sting, <strong>H</strong>yperlipidemia/hypercalcemia, <strong>E</strong>RCP, <strong>D</strong>rugs (thiazides, azathioprine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe epigastric pain</strong> (radiates to back, worsens after food), <strong>nausea, vomiting, fever</strong>. Severe cases: <strong>Cullen’s Sign</strong> (periumbilical bruising), <strong>Grey Turner’s Sign</strong> (flank bruising), <strong>Colon Cutoff Sign</strong> (gas-filled, distended <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> with abrupt cut-off at splenic <span class=\"customMeta\" data-dictid=\"13e47cfa68169277720299cd54beb4\">flexure</span> due to inflammation).<strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis (Atlanta Criteria)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>≥2 of 3 criteria</strong>: (1) <strong>Lipase &gt;3x ULN</strong> (more specific than amylase), (2) <strong>Epigastric pain</strong>, (3) <strong>Imaging (CT/USG/MRI) evidence</strong>. <strong>CT scan</strong> (best for complications), <strong>Ultrasound</strong> (detects gallstones).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild:</strong> No organ failure, <strong>Moderate:</strong> &lt;48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> organ failure, <strong>Severe:</strong> &gt;48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> organ failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV Fluids (Ringer’s lactate), <span class=\"customMeta\" data-dictid=\"cc5c05259716927771933078784603\">NPO</span> (Bowel Rest), Pain Control (IV opioids), and <span class=\"customMeta\" data-dictid=\"b36da50c8d169277718782ffc6960b\">Enteral</span> <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> are preferred over TPN. <span class=\"customMeta\" data-dictid=\"b2276d3d4c16927771872281723792\">ERCP</span> only if <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> with cholangitis. No routine antibiotics unless infected necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early (&lt;1 week): SIRS, Shock, ARDS, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> failure, DIC, Hypocalcemia. Late (&gt;1 week): <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">Necrosis</span> (sterile/infected), Pseudocyst, Abscess, Chronic Pancreatitis, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> obstruction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man is brought to the casualty with severe abdominal pain radiating to the back for the past 1 day and has had 3 episodes of vomiting. The pain radiates to the back and is slightly relieved in the sitting forward position. The following signs are seen on examination and lab investigations reveal elevated lipase and amylase. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute appendicitis", "correct": false}, {"label": "B", "text": "Acute cholecystitis", "correct": false}, {"label": "C", "text": "Acute pancreatitis", "correct": true}, {"label": "D", "text": "Acute ischemic colitis", "correct": false}], "correct_answer": "C. Acute pancreatitis", "question_images": ["https://image.prepladder.com/notes/daOHYTBptx80YJZAmQTY1747728103.png"], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure shown in the image:", "options": [{"label": "A", "text": "Beger’s procedure", "correct": false}, {"label": "B", "text": "Whipple’s procedure", "correct": true}, {"label": "C", "text": "Frey’s procedure", "correct": false}, {"label": "D", "text": "Pancreatic redivision", "correct": false}], "correct_answer": "B. Whipple’s procedure", "question_images": ["https://image.prepladder.com/content/vRfENICQHf519B9iom5r1746012946.png"], "explanation_images": ["https://image.prepladder.com/content/spfAgl5Mtn7RAigOrrT11747911307.png", "https://image.prepladder.com/content/M46lrnEGp5VvxBT2OZqY1747911315.png"], "explanation": "<p>Correct answer B) Whipple’s procedu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Whipple’s procedure </strong></p>\n<p>(pancreaticoduodenectomy)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Structures removed: Head of the pancreas, the first part of the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (duodenum), the gallbladder, and a portion of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</p>\n<p>Types:</p>\n<ul>\n<li>Pylorus-Preserving Whipple Procedure</li>\n<li>Non–Pylorus-Preserving Whipple Procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic Cancer:</strong> Commonly treated with Whipple if cancer is <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the head of the pancreas.</p>\n<p><strong>Chronic Pancreatitis:</strong> when uncontrolled by medical management.</p>\n<p><strong>Tumors in Pancreas/Surrounding Areas:</strong> Includes duodenum, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, and <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure Steps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor Assessment: Explore <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to assess tumor size, location, and spread.</p>\n<p>Resection: Remove head of pancreas, duodenum, gallbladder, and part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct; this may include partial stomach resection.</p>\n<p>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection: Remove and examine nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cancer Research UK\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Diagram_showing_the_parts_removed_with_a_Whipple%27s_operation_CRUK_337.svg\" data-tags=\"\" height=\"3810\" src=\"https://image.prepladder.com/content/spfAgl5Mtn7RAigOrrT11747911307.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reconstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreaticojejunostomy:</strong> Connect remaining <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> to jejunum. <strong>Hepaticojejunostomy:</strong> Connect common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> to jejunum. <strong>Gastrojejunostomy:</strong> Connect stomach to jejunum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anastomosis Principles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tension-Free Connection:</strong> Achieve mucosa-to-mucosa connection for healing.</p>\n<p><strong>Order of Anastomoses: </strong>Pancreaticojejunostomy → <span class=\"customMeta\" data-dictid=\"db93ca9acc1692777188412df8a3d4\">Hepaticojejunostomy</span> → Gastrojejunostomy</p>\n<p><strong>Stent Placement: </strong>May use internal/external stents for small ducts.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"708\" src=\"https://image.prepladder.com/content/M46lrnEGp5VvxBT2OZqY1747911315.png\" width=\"738\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pancreatic Fistula: Major issue; managed with <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues.</li>\n<li>Delayed Gastric Emptying</li>\n<li>Bleeding, wound infection</li>\n<li>Reoperation, increased mortality</li>\n<li>Dumping/Bile Reflux: Common after non-pylorus-preserving Whipple; pylorus-preserving method has uncertain benefits.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure shown in the image below.", "options": [{"label": "A", "text": "Gastrojejunostomy", "correct": false}, {"label": "B", "text": "Pancreaticojejunostomy", "correct": true}, {"label": "C", "text": "Pancreatic Ileostomy", "correct": false}, {"label": "D", "text": "Duodenojejunostomy", "correct": false}], "correct_answer": "B. Pancreaticojejunostomy", "question_images": ["https://image.prepladder.com/content/78H6WpweVHHLlWRUI2Lq1747911381.png"], "explanation_images": [], "explanation": "<p>Correct answer B) Pancreaticojeju\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36-year-old man presents with dull aching epigastric pain. He gives a history of acute abdominal pain following a binge of alcohol 5 weeks back, which was managed conservatively. On examination, he appeared icteric, and a firm mass was palpable in the epigastrium. His CT scan is given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pancreatic pseudocyst", "correct": true}, {"label": "B", "text": "Large choledochal cyst", "correct": false}, {"label": "C", "text": "Gastric duplication cyst", "correct": false}, {"label": "D", "text": "Mesenteric cyst", "correct": false}], "correct_answer": "A. Pancreatic pseudocyst", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Pancreatic pseu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 42-year-old woman who came with symptoms of fever, vomiting, and right hypochondriac pain, which radiates to the neck? She has experienced similar episodes in the past, and a positive Murphy's sign was observed during the examination.", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": true}, {"label": "B", "text": "Carcinoma gallbladder", "correct": false}, {"label": "C", "text": "Peptic ulcer", "correct": false}, {"label": "D", "text": "Acute appendicitis", "correct": false}], "correct_answer": "A. Acute cholecystitis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tokyo Guidelines for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">Cholecystitis</span> (2013/2018)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A) Local Signs of Inflammation</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Murphy's sign</strong></li>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RUQ) pain/ <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> or a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B) <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> Signs of Inflammation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Elevated CRP</li>\n<li>Elevated WBC</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C) <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Findings:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gallbladder wall thickening (&gt;3 mm)</li>\n<li>Pericholecystic fluid,</li>\n<li>Ultrasonographic Murphy's sign.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate next step in the management of a female patient who has abdominal pain, multiple gallstones with no thickening of the gallbladder wall as seen on ultrasound, a common bile duct diameter of 12mm, serum bilirubin level of 0.8, alkaline phosphatase level of 380, and a 5-fold increase in GGT?", "options": [{"label": "A", "text": "MRCP", "correct": true}, {"label": "B", "text": "ERCP", "correct": false}, {"label": "C", "text": "Endoscopic ultrasound", "correct": false}, {"label": "D", "text": "Laparoscopic cholecystectomy", "correct": false}], "correct_answer": "A. MRCP", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40 year old woman presented with jaundice, fever, and abdominal pain. She is suspected to have cholangitis. Which of the following apart from abdominal pain makes up Reynold pentad? 1. Fever 2. Jaundice 3. Hypotension 4. Altered sensorium 5. Hematemesis 6. Melena", "options": [{"label": "A", "text": "1, 2, 3, 4", "correct": true}, {"label": "B", "text": "2, 3, 4, 5", "correct": false}, {"label": "C", "text": "1, 3, 4, 5", "correct": false}, {"label": "D", "text": "1, 2, 4, 5", "correct": false}], "correct_answer": "A. 1, 2, 3, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cholangitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, leading to bacterial infection by organisms like Klebsiella, E. coli, Enterobacter, Pseudomonas, and <span class=\"customMeta\" data-dictid=\"e58661c5961692777184ecb7121396\">Citrobacter</span> species.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Charcot's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> - pain, jaundice, fever</strong></li>\n<li>Additional <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b2332a96a2169277718756eb10e3e7\">epigastrium</span> and right <span class=\"customMeta\" data-dictid=\"c8bf2605091692777189746f65e812\">hypochondrium</span> is common.</li>\n<li>Severe Form: <strong>Reynolds pentad</strong> - <strong>persistent pain, fever, jaundice, shock, and altered mental status</strong></li>\n<li>Indicates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> obstructive <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> count, bilirubin, and <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> levels.</li>\n<li>Chronic cases may show <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> or hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recurrent <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">Pyogenic</span> Cholangitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More common in East Asian populations, caused by <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> stones and infections</li>\n<li>Risk factors include <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> infections like <span class=\"customMeta\" data-dictid=\"1d97210e3416927771844d6a6b6242\">Clonorchis</span> sinensis and <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> lumbricoides.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about hepatocellular carcinoma (HCC) is/are correct? 1. TACE(Transarterial chemoembolization) is used for multinodular lesions 2. Lenvatinib is used for lesions less than 3 cm 3. The incidence of HCC is increasing 4. NASH and NAFLD are risk factors for HCC", "options": [{"label": "A", "text": "1, 2, 3", "correct": false}, {"label": "B", "text": "2, 3, 4", "correct": false}, {"label": "C", "text": "1, 3, 4", "correct": true}, {"label": "D", "text": "1 and 2", "correct": false}], "correct_answer": "C. 1, 3, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Statement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True/False</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. TACE (Transarterial Chemoembolization) is used for <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">multinodular</span> lesions.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TACE is used in <strong>intermediate-stage (BCLC B) HCC</strong> with <strong>multiple nodules</strong> and <strong>preserved liver function</strong> (Child-Pugh A/B).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Lenvatinib is used for lesions less than 3 cm.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>False</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lenvatinib is a <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> therapy for advanced HCC (BCLC C)</strong>. Small <strong>(&lt;3 cm) tumors are treated with resection, RFA, or liver transplant</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. The <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of HCC is increasing.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of <strong>HCC is rising globally</strong> due to <strong>increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> syndrome, NAFLD/NASH, obesity, and <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B/C</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. <span class=\"customMeta\" data-dictid=\"8797267c6a1692777193c11b118e72\">NASH</span> and NAFLD are risk factors for HCC.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NAFLD/NASH are leading non-viral causes of HCC</strong>. They can cause HCC <strong>even in non-cirrhotic livers</strong> due to chronic inflammation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most helpful test to identify the underlying cause in a 56-year-old patient with obstructive jaundice, who presents with a distended gall bladder, dilated common bile duct, and enlarged intrahepatic biliary radicles on ultrasound?", "options": [{"label": "A", "text": "Magnetic Resonance Cholangiopancreatography", "correct": true}, {"label": "B", "text": "Endoscopic ultrasound", "correct": false}, {"label": "C", "text": "Percutaneous transhepatic cholangiography", "correct": false}, {"label": "D", "text": "Endoscopic retrograde cholangiopancreatography", "correct": false}], "correct_answer": "A. Magnetic Resonance Cholangiopancreatography", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/JnmPbAzwewdXnG2F7EFv1746446946.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INVESTIGATIONS - CHOLEDOCHAL CYST</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Ultrasound</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The first <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test that is performed.</li>\n<li>Confirms the presence of the cyst.</li>\n<li>Reveals <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> details, including <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> and pancreatic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> relationship.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic Resonance Cholangiopancreatography (MRCP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-invasive <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> technique. Provides detailed images of the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> and <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system.</li>\n<li>Highly sensitive (&gt;90%) and specific (&gt;99%) for identifying common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> stones.</li>\n<li>Visualizes <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and the extent of dilatation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Retrograde Cholangiopancreatography (ERCP):</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive procedure with <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> and contrast material.</li>\n<li>Diagnostic and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> capabilities (tissue sampling, decompression, treatment of choledocholithiasis).</li>\n<li>Effective but has a <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rate of up to 10%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Percutaneous Transhepatic Cholangiography (PTC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive procedure with a needle directly into the liver.</li>\n<li>Useful for <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> disease or when ERCP is not feasible. <strong>(Option C ruled out)</strong></li>\n<li>Helps delineate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and enables <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> and <span class=\"customMeta\" data-dictid=\"cb33defbb316927771991b2ef81ec3\">stent</span> placement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT SCAN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly to see the <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatobiliary <span class=\"customMeta\" data-dictid=\"7f1cbc3c0c1692777193ca23ddc2b5\">nuclide</span> Scanning</li>\n<li>Liver Function Tests</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action in the management of a female patient who experienced abdominal pain and increased heart rate three days after cholecystectomy? Her white blood cell count is 11000 cells / mm^3, and an ultrasound examination revealed a 5x5 cm accumulation of fluid in the sub-hepatic space on the right side.", "options": [{"label": "A", "text": "Antibiotics and send home", "correct": false}, {"label": "B", "text": "USG-guided pigtail catheter drainage", "correct": true}, {"label": "C", "text": "Laparoscopy and re-exploration", "correct": false}, {"label": "D", "text": "ERCP and T-tube placement", "correct": false}], "correct_answer": "B. USG-guided pigtail catheter drainage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) USG-guided pigtail &lt;span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\"&gt;catheter&lt;/span&gt; drainag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the classical triad of acute cholangitis?", "options": [{"label": "A", "text": "Pain, jaundice, fever", "correct": true}, {"label": "B", "text": "Pain, jaundice, shock", "correct": false}, {"label": "C", "text": "Fever, jaundice, ↑WBC", "correct": false}, {"label": "D", "text": "Pain, ↑WBC, ↑Bilirubin", "correct": false}], "correct_answer": "A. Pain, jaundice, fever", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Cholangitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, leading to bacterial infection by organisms like Klebsiella, E. coli, Enterobacter, Pseudomonas, and <span class=\"customMeta\" data-dictid=\"e58661c5961692777184ecb7121396\">Citrobacter</span> species.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Charcot's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> - pain, jaundice, fever</strong></li>\n<li>Additional <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b2332a96a2169277718756eb10e3e7\">epigastrium</span> and right <span class=\"customMeta\" data-dictid=\"c8bf2605091692777189746f65e812\">hypochondrium</span> is common.</li>\n<li>Severe Form: <strong>Reynolds pentad</strong> - <strong>persistent pain, fever, jaundice, shock, and altered mental status</strong></li>\n<li>Indicates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> obstructive <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> count, bilirubin, and <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> levels.</li>\n<li>Chronic cases may show <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> or hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recurrent <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">Pyogenic</span> Cholangitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More common in East Asian populations, caused by <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> stones and infections</li>\n<li>Risk factors include <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> infections like <span class=\"customMeta\" data-dictid=\"1d97210e3416927771844d6a6b6242\">Clonorchis</span> sinensis and <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> lumbricoides.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic patient presented with severe abdominal pain. Pancreatitis was suspected, and a CT scan revealed lesions with fluid collected near the body of the pancreas. Which of the following enzymes is most likely to be elevated?", "options": [{"label": "A", "text": "Serum GGT", "correct": false}, {"label": "B", "text": "CEA", "correct": false}, {"label": "C", "text": "Serum lipase", "correct": true}, {"label": "D", "text": "Serum bilirubin", "correct": false}], "correct_answer": "C. Serum lipase", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/J4BS6hZKh91lANvf7RLs1746451314.png", "https://image.prepladder.com/notes/KEMOv3frHXrq0JsobkOA1746451338.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>X-ray Features</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sentinel loop sign</strong>:\n\t\t\t\t<ul>\n<li>Dilated loop of small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> near the inflamed <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to localised ileus.</li>\n<li><strong>Significance</strong>: Early indicator of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> on X-ray.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<p>Sentinel loop sign</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Sentinel loop sign\" data-author=\"Mohammad Niknejad\" data-hash=\"12074\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/sentinel-loop-acute-appendicitis-2#image-3004244\" data-tags=\"May2025\" height=\"226\" src=\"https://image.prepladder.com/notes/J4BS6hZKh91lANvf7RLs1746451314.png\" width=\"168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Colon cut-off sign</strong>:\n\t\t\t\t<ul>\n<li>Abrupt <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> at the splenic flexure, with collapsed <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> loops.</li>\n<li><strong>Significance</strong>: Suggests localised pancreatic inflammation, causing <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> as an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> pancreatitis</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Colon cut-off sign\" data-author=\"Cerevisae\" data-hash=\"12077\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Colonic_cut_off_sign_on_chest_X-ray.jpg\" data-tags=\"May2025\" height=\"216\" src=\"https://image.prepladder.com/notes/KEMOv3frHXrq0JsobkOA1746451338.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female patient presents with abdominal pain and bilious vomiting. She had a history of abdominal hysterectomy 2 years back. On examination, abdomen auscultation revealed high-pitched bowel sounds. Investigations showed air within the biliary tree. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gallstone ileus", "correct": true}, {"label": "B", "text": "Adhesive intestinal obstruction", "correct": false}, {"label": "C", "text": "Ischemic enterocolitis", "correct": false}, {"label": "D", "text": "Diverticulitis", "correct": false}], "correct_answer": "A. Gallstone ileus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ibHave4RpDAsrsPtTuIj1746451658.png", "https://image.prepladder.com/notes/7rARuvcgVWB0GkLpuu0l1746451682.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "ERCP is least useful in the diagnosis of:", "options": [{"label": "A", "text": "Recurrent pancreatitis", "correct": false}, {"label": "B", "text": "Unexplained jaundice", "correct": false}, {"label": "C", "text": "Periampullary mass", "correct": false}, {"label": "D", "text": "Acute Pancreatitis without choledocholithiasis", "correct": true}], "correct_answer": "D. Acute Pancreatitis without choledocholithiasis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with pain in the right upper quadrant on the second postoperative day following a cholecystectomy. Evaluation reveals a collection in the subhepatic space. A bile leak is suspected. Which of the following is the best investigation for this patient?", "options": [{"label": "A", "text": "MRCP", "correct": false}, {"label": "B", "text": "ERCP", "correct": true}, {"label": "C", "text": "HIDA", "correct": false}, {"label": "D", "text": "CECT", "correct": false}], "correct_answer": "B. ERCP", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/leJ8YuWFizLx3mZ9mN4s1745476057.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Endoscopic Retrograde Cholangiopancreatography (ERCP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>It is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> procedure used to examine and treat disorders of the <strong>bile ducts</strong>, <strong>pancreatic ducts</strong>, and <strong>gallbladder</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>It allows for visual assessment of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> and <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</li>\n<li>Allows biopsies, stone extraction, and other Interventional procedures like sphincterotomy, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> stenting, and <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> dilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>In Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less suitable for jaundiced patients as it is invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Imaging Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Provides dynamic information during contrast introduction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"J. Guntau at German Wikipedia\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ERCP_Roentgen.jpg\" data-tags=\"\" height=\"407\" src=\"https://image.prepladder.com/content/leJ8YuWFizLx3mZ9mN4s1745476057.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to Strasberg's classification of bile duct injuries, injury to the right aberrant posterior sectoral duct with bile leak is:", "options": [{"label": "A", "text": "Type A", "correct": false}, {"label": "B", "text": "Type B", "correct": false}, {"label": "C", "text": "Type C", "correct": true}, {"label": "D", "text": "Type D", "correct": false}], "correct_answer": "C. Type C", "question_images": ["https://image.prepladder.com/content/3N29LvZfy42vUOWWlzb51745476816.png"], "explanation_images": ["https://image.prepladder.com/content/fN8vasfYVxqxbZjSgWKE1745476926.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>The Strasberg <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type A <strong>(M/C)</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> leak or leak from sub-vesical <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> of Luschka</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type B</p>\n<p><strong>(Option Bruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ligation or <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type C</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transection without <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of the <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type D</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of the Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type E</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E1 to E5 Bismuth classification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with recurrent pain in the right hypochondrium, nausea, and vomiting is diagnosed with biliary dyskinesia. Which of the following is least useful in the diagnosis of this condition?", "options": [{"label": "A", "text": "ERCP", "correct": false}, {"label": "B", "text": "HIDA scan", "correct": false}, {"label": "C", "text": "USG", "correct": true}, {"label": "D", "text": "Post-surgery follow-up", "correct": false}], "correct_answer": "C. USG", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child with Wilson's disease is being considered for liver transplantation. Which of the following is not a parameter in the selection criteria for transplantation?", "options": [{"label": "A", "text": "Age &amp;lt; 10 years", "correct": false}, {"label": "B", "text": "PT &amp;gt; 100 s", "correct": false}, {"label": "C", "text": "Bilirubin &amp;gt; 300 μmol/L", "correct": false}, {"label": "D", "text": "Jaundice less than 7 days before the development of encephalopathy", "correct": true}], "correct_answer": "D. Jaundice less than 7 days before the development of encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\"&gt;Jaundice&lt;/span&gt; less than 7 days before the development of encephalopathy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laboratory measurement </strong></p>\n<p style=\"text-align: center;\"><strong>(Other options ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score (in points) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Serum bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.2-1.2 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;5.8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5.8-8.8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">8.8-11.7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">11.7-17.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;17.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Serum <span class=\"customMeta\" data-dictid=\"3d988dbcc816927771821e9a2544f7\">aspartate</span> transferase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">10-35 IU/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">100-150</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">151-200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">201-300</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;300</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Prolongation of <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> time (seconds)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">4-8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">9-12</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">13-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;20</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 80-year-old woman presented with fatigue. Imaging revealed a scleroatrophic gallbladder with impacted stones and a large stone in the common bile duct, causing dilation of the biliary tree. What is the next step in management?", "options": [{"label": "A", "text": "Immediately take up the patient for cholecystectomy", "correct": false}, {"label": "B", "text": "Endoscopic retrograde cholangiopancreatography", "correct": true}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "B. Endoscopic retrograde cholangiopancreatography", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/6BOOlzmJhHsHto97MOeQ1746432523.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Choledocholithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound:</strong> Useful for detecting gallstones and CBD <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> but has limited sensitivity for CBD stones.</li>\n<li><strong>MRCP:</strong> Non-invasive, excellent for visualising <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and pathology.</li>\n<li><strong>ERCP:</strong> Highly sensitive, both <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> for CBD stones.</li>\n<li><strong>PTC:</strong> Used when ERCP is not feasible, such as post-gastrectomy patients or unsuccessful ERCP attempts.</li>\n<li><strong>EUS:</strong> <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> but accurate for diagnosing choledocholithiasis.</li>\n<li><strong>Blood Tests:</strong> ↑ bilirubin, ↑alkaline phosphatase, and ↑white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> indicate <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and possible complications like cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Endoscopic Management:</strong> ERCP with <span class=\"customMeta\" data-dictid=\"175e83e48b1692777199af3924b28b\">sphincterotomy</span> and stone extraction; stenting if necessary.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"SU074\" data-author=\"Samir धर्म \" data-hash=\"11786\" data-license=\"CC BY-SA 3.0\" data-source=\"File:ERCP stone.jpg - Wikimedia Commons\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/6BOOlzmJhHsHto97MOeQ1746432523.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Percutaneous Removal:</strong> Used when <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> access is difficult.</li>\n<li><strong>Surgery:</strong> Options include <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> and open choledocholithotomy, choledochoduodenostomy, and choledochojejunostomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cholangitis:</strong> Bacterial infection due to obstructed <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow, leading to fever, chills, right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, and jaundice.</li>\n<li><strong>Pancreatitis:</strong> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</li>\n<li><strong>Liver Damage:</strong> Prolonged <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> can cause <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> and liver failure.</li>\n<li><strong>Biliary Stricture:</strong> Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> can lead to the narrowing of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts.</li>\n<li><strong>Gallstone Ileus:</strong> Large <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> eroding into the intestine, causing mechanical obstruction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presented with recurrent episodes of fever with chills. The MRCP image is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary sclerosing cholangitis", "correct": true}, {"label": "B", "text": "Caroli disease", "correct": false}, {"label": "C", "text": "Oriental cholangitis", "correct": false}, {"label": "D", "text": "Primary biliary carcinoma", "correct": false}], "correct_answer": "A. Primary sclerosing cholangitis", "question_images": ["https://image.prepladder.com/content/W9JyjZrllfxV3MxG83fg1746515978.png"], "explanation_images": ["https://image.prepladder.com/content/kfIydjtjKGng4YGUhjnV1746516013.png", "https://image.prepladder.com/content/lgHOIDewNgZYogQcO5g21746516013.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">Cholangitis</span> (PSC)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PSC is characterised by <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and obliterative <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> and large <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts, with <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of preserved segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It commonly occurs in individuals aged 30-50 years.</li>\n<li>Has a male predominance of 2:1.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It suggests an <strong>immunologically mediated process</strong> supported by circulating autoantibodies and T lymphocytes in the <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> stroma, as well as associations with<strong> HLA-B8</strong> and <strong>ulcerative colitis</strong>.</li>\n<li>A mix of <strong>environmental </strong>&amp; genetic factors may trigger <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury.</li>\n<li>Increased risk of PSC in first-degree relatives indicates a genetic component.</li>\n<li>Activated T cells from <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may migrate to the liver, <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> antigens.</li>\n<li>Changes in the intestinal microbiome or infections may alter cholangiocytes, causing inflammation.</li>\n<li>Atypical <span class=\"customMeta\" data-dictid=\"2da8fc47cf169277719576cea1851f\">perinuclear</span> antineutrophil cytoplasmic antibodies (pANCA) are</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common symptoms include fatigue, pruritus, and jaundice.</li>\n<li>Nearly 50% of patients are <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> at diagnosis, often identified through elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase.</li>\n<li>Ascending cholangitis, chronic pancreatitis, and chronic <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">cholecystitis</span> may also occur.</li>\n<li>Fibrosis can progress to <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> over 10-15 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ERCP/MRCP shows the <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">beaded</span> appearance of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Knipe H, Walizai T, Rasuli B\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/primary-sclerosing-cholangitis\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/kfIydjtjKGng4YGUhjnV1746516013.png\" width=\"305\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Biopsy,\n\t\t\t\t<ul>\n<li>Early features:\n\t\t\t\t\t<ul>\n<li>Periductal<strong> \"onion skin\" fibrosis</strong> &amp; inflammation</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> &amp; <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ductular proliferation</li>\n</ul>\n</li>\n<li>Later stages show progressive <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> leading to <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> and obliterative cholangitis, resulting in <strong>\"vanishing <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> syndrome\"</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Raul S. Gonzalez\" data-hash=\"\" data-license=\"NA\" data-source=\"Pathology Outlines - Primary sclerosing cholangitis\" data-tags=\"\" height=\"285\" src=\"https://image.prepladder.com/content/lgHOIDewNgZYogQcO5g21746516013.png\" width=\"337\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcerative colitis, risk of developing cholangiocarcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lifetime risk of developing <strong>cholangiocarcinoma</strong> is about 20%.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young sheep farmer presents to the OPD with pain in the right upper part of the abdomen. Upon examination, there was tenderness and enlargement of the liver. Blood investigations show eosinophilia, elevated liver enzymes, and abdominal ultrasound, as shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Amoebic liver abscess", "correct": false}, {"label": "B", "text": "Hydatid cyst", "correct": true}, {"label": "C", "text": "Pyogenic liver abscess", "correct": false}, {"label": "D", "text": "Hepatocellular carcinoma", "correct": false}], "correct_answer": "B. Hydatid cyst", "question_images": ["https://image.prepladder.com/content/9vf2nMRm75wHpTuO2cyP1746983419.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hydatid cyst</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Echinococcus granulosus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Commonly Affected Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Liver (most common site, about 60-70% of cases)</li>\n<li>Lungs (second most common site)</li>\n<li>Other organs (rare but possible): Brain, spleen, kidneys, bones, and peritoneum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymptomatic Phase: </strong>Common due to slow <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> growth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptomatic Phase:</strong></p>\n<ul>\n<li>Liver Involvement: Mostly right lobe; Abdominal pain, hepatomegaly, obstructive jaundice, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension.</li>\n<li>Lung Involvement: Cough, chest pain, dyspnea, hemoptysis, pneumothorax.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Studies:</strong></p>\n<ul>\n<li><strong>USG</strong> is the first-line <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modality, particularly for liver involvement.\n\n\t\t\t\t<ul>\n<li><strong>Features: </strong>Echinococcal <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall shows double <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> lines separated by a <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> layer (double contour)</li>\n</ul>\n</li>\n<li><strong>CT Scan</strong></li>\n<li><strong>MRI</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serological Tests:</strong></p>\n<ul>\n<li>ELISA</li>\n<li>Immunoblotting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other tests:</strong></p>\n<ul>\n<li>Casoni Intradermal Test</li>\n<li>ARC5 Immunoelectrophoresis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:582px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>WHO Classification of Hydatid cyst</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyst Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilocular Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> and no visible <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Simple Active Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Double-line sign</strong>; well-defined <span class=\"customMeta\" data-dictid=\"acb59b05f31692777181d2df5f618b\">anechoic</span> cyst</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multivesicular Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Honeycomb appearance: </strong>Visible <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall and internal septations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transitional Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Have detached <span class=\"customMeta\" data-dictid=\"60871f0132169277719130bf2568f0\">laminar</span> membranes or may be partially collapsed and floating within the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (<strong>Water-lily sign</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-homogenous mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with a thick calcified wall</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a tumour marker of pancreatic cancer?", "options": [{"label": "A", "text": "NSE", "correct": false}, {"label": "B", "text": "Alpha-Fetoprotein", "correct": false}, {"label": "C", "text": "Ca 15-3", "correct": false}, {"label": "D", "text": "CA 19-9", "correct": true}], "correct_answer": "D. CA 19-9", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tumor markers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha-fetoprotein</strong></p>\n<p><strong>(AFP)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</li>\n<li>Hepatoblastoma</li>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumour (endodermal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tumour)</li>\n<li>Nonseminomatous <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour of testis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>↑ AFP: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall defects, <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects</li>\n<li>↓ AFP: associated with <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 21, 18, and 13</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>β-HCG</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nonseminomatous testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumours (choriocarcinoma, embryonal cell carcinoma, mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour, seminoma)</li>\n<li>Ovarian cancer: <span class=\"customMeta\" data-dictid=\"209abd0cee16927771843bab0de87c\">choriocarcinoma</span> (gestational trophoblastic disease)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Colorectal cancer</li>\n<li>Pancreatic cancer</li>\n<li>Breast cancer</li>\n<li>Lung cancer (especially in non-small cell cancers)</li>\n<li>Gastric cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prostate cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Benign prostatic hyperplasia</li>\n<li>Prostatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer (both <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> and associated with MEN 1 and MEN 2)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alkaline phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastases to bone or liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paget disease of the bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Placental <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seminoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactate dehydrogenase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian cancer (dysgerminoma)</li>\n<li>Testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumours (both <span class=\"customMeta\" data-dictid=\"0b7129b26c16927771988bb64b78ef\">seminoma</span> and nonseminoma)</li>\n<li>Lymphomas</li>\n<li>Ewing's sarcoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuron specific <span class=\"customMeta\" data-dictid=\"92417be2b316927771877be984d041\">enolase</span> (NSE)</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neuroendocrine tumors</li>\n<li>Small cell lung cancer</li>\n<li>Carcinoid tumour</li>\n<li>Neuroblastoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 19–9 (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pancreatic adenocarcinoma</li>\n<li>Colon cancer</li>\n<li>Cholangiocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 15–3 and CA 27–29 (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breast cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 125 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian carcinoma</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"29c037b45616927771886c286ed45b\">gynecologic</span> malignancies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S-100 protein (S100A) and (S100B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignant melanoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SMRP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesothelioma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent a laparoscopic cholecystectomy for cholelithiasis. A picture of the resected gall bladder is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Gall bladder carcinoma", "correct": true}, {"label": "B", "text": "Mixed stone in gallbladder", "correct": false}, {"label": "C", "text": "Cholecystitis", "correct": false}, {"label": "D", "text": "Choledocholithiasis", "correct": false}], "correct_answer": "A. Gall bladder carcinoma", "question_images": ["https://image.prepladder.com/notes/AcNnhAngRLRwGNGbXQoW1747998454.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gall <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gallstones, (The risk of developing <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> disease is 7-10 times higher than in the general population)</li>\n<li>Porcelain gallbladder,</li>\n<li>PSC,</li>\n<li>Abnormal pancreatic-biliary junction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often indistinguishable from <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> diseases</li>\n<li>Symptoms include:\n\t\t\t\t<ul>\n<li>Biliary colic</li>\n<li>Cholecystitis (especially in older individuals)</li>\n<li>Jaundice (late-stage)</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> (late-stage)</li>\n<li>Palpable mass (late-stage)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-specific indicators:\n\t\t\t\t<ul>\n<li>Anemia</li>\n<li>Leukocytosis</li>\n<li>Slight increase in transaminases</li>\n</ul>\n</li>\n<li>Tumor markers:\n\t\t\t\t<ul>\n<li>Elevated CA19-9</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"11b3cfa9a31692777183e48dccbc39\">carcinoembryonic</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (in ~80% of patients)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography (USG):</strong> Initial diagnosis</li>\n<li><strong>CT Scans:</strong> Thorax, abdomen, and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> for confirmation and staging</li>\n<li><strong>MRI/MRCP:</strong> For accurate <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> staging</li>\n<li><strong>PET Scans:</strong> To identify metastatic disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staging &amp; Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Preoperative Staging: </strong>Crucial to assess local disease extent and rule out distant metastases</li>\n<li><strong>Percutaneous Biopsy:</strong> Guided by radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for unresectable tumours</li>\n<li><strong>Laparoscopic Examination:</strong> Detects peritoneal or liver <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> that preclude surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term for a stone obstructing the cystic duct, causing dilation of the common hepatic duct, resulting in CBD obstruction and jaundice?", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": false}, {"label": "B", "text": "Porcelain gallbladder", "correct": false}, {"label": "C", "text": "Cholesterolosis", "correct": false}, {"label": "D", "text": "Mirizzi’s syndrome", "correct": true}], "correct_answer": "D. Mirizzi’s syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/25YL4ccIK5LGxnEl8Kqp1748162999.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mirizzi’s syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> usually impacts from the Hartmann's pouch, leading to <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the CHD/CBD.</li>\n<li>Can also occur from the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> of the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> into the CBD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Abdominal pain</li>\n<li>Obstructive jaundice</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> on the right side</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> soft, enlarged liver</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Csendes Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I - Extrinsic compression</strong> of the CBD/CHD by a large <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> stone in Hartmann's pouch;</p>\n<ul>\n<li>IA- the presence of <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n<li>IB- is obliterated <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II - </strong>The stone has eroded the CBD/CHD less than 1/3rd of the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD, forming a fistula</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III - </strong>Involving up to 2/3rd of the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of CBD/ CHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV - </strong>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (&gt;2/3rd) involving the entire <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type V - </strong>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> with cholecystoenteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> without <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VA) or with</p>\n<p>gallstone <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VB)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"270\" src=\"https://image.prepladder.com/content/25YL4ccIK5LGxnEl8Kqp1748162999.png\" width=\"926\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography (USG):</strong> Initial <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to assess <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> and ducts.</li>\n<li><strong>CT Scan: </strong>Provides detailed <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> of the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system.</li>\n<li><strong>ERCP/ MRCP:</strong> Essential for delineating <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and identifying the site of obstruction.</li>\n<li><strong>HIDA Scan:</strong> Useful for <span class=\"customMeta\" data-dictid=\"c7de83b272169277720260f08186c4\">functional assessment</span> of the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system.</li>\n<li><strong>Findings:</strong> Dilatation of the <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system with a block at the common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CHD).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old woman had her routine follow-up, and her USG of the liver is shown below. She is asymptomatic at present but has a history of mild right hypochondriac pain, which is relieved by taking analgesics. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gallstones", "correct": true}, {"label": "B", "text": "Amoebic liver abscess", "correct": false}, {"label": "C", "text": "Hydatid cyst", "correct": false}, {"label": "D", "text": "Acute cholecystitis", "correct": false}], "correct_answer": "A. Gallstones", "question_images": ["https://image.prepladder.com/content/2rZH90yQw5DNom1dHDUK1747121460.png"], "explanation_images": ["https://image.prepladder.com/content/rPEY8cDIi5u21M6Hk58e1748163093.png", "https://image.prepladder.com/content/ByjAZEGPEsFrgwnAlkAv1747121486.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with abdominal pain in the emergency room. . On examination, there is blackish discoloration involving the periumbilical skin . What is the most likely diagnosis for this presentation?", "options": [{"label": "A", "text": "Acute pancreatitis", "correct": true}, {"label": "B", "text": "Necrotizing fasciitis", "correct": false}, {"label": "C", "text": "Chronic pancreatitis", "correct": false}, {"label": "D", "text": "Traumatic fat necrosis", "correct": false}], "correct_answer": "A. Acute pancreatitis", "question_images": ["https://image.prepladder.com/content/ixEC3qlnzj3uTiHwPdQk1714383788.png"], "explanation_images": ["https://image.prepladder.com/content/gpP0KKonxRaQBDKI5wYW1714383802.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked structure?", "options": [{"label": "A", "text": "Cystic artery", "correct": false}, {"label": "B", "text": "Right Hepatic artery", "correct": true}, {"label": "C", "text": "Hepatic duct", "correct": false}, {"label": "D", "text": "Cystic duct", "correct": false}], "correct_answer": "B. Right Hepatic artery", "question_images": ["https://image.prepladder.com/content/7vGJC3a2fSKtuZfJdDB81741105464.png"], "explanation_images": ["https://image.prepladder.com/content/l3G1WweZ7qBkY3roLwtP1741105597.png", "https://image.prepladder.com/content/rh4ubsFoW9av32ruf1Rr1741105663.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proper <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (branch of Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> Artery)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs behind the common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> and ascends toward the right <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (to gallbladder), <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> branches to liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the right <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the liver and gallbladder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury during <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> can lead to <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> or <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> ischemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the stage of disease given in the image.", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2", "correct": true}, {"label": "C", "text": "Type 3", "correct": false}, {"label": "D", "text": "Type 4", "correct": false}], "correct_answer": "B. Type 2", "question_images": ["https://image.prepladder.com/content/Yumudfhr1BNCdACqVjtJ1724928271.png"], "explanation_images": ["https://image.prepladder.com/content/Kn4vLBH4VhjHuLki2bkc1724850292.png"], "explanation": "<p>Correct Option B - Type 2:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>WHO-IWGE staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gharbi classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilocular <span class=\"customMeta\" data-dictid=\"acb59b05f31692777181d2df5f618b\">anechoic</span> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with double line sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiseptated, \"rosette-like\" \"honeycomb\" cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE3 A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with detached membranes (water-lily sign)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transitional</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE3 B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with daughter cysts in solid matrix</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transitional</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with <span class=\"customMeta\" data-dictid=\"b2dafdf91e16927771884f1d4b5107\">heterogenous</span> hypoechoic/hyperechoic contents. No daughter cysts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solid <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> with calcified wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the disease?", "options": [{"label": "A", "text": "Renal cyst", "correct": true}, {"label": "B", "text": "Renal tumor", "correct": false}, {"label": "C", "text": "ADPKD", "correct": false}, {"label": "D", "text": "Hydatid cyst", "correct": false}], "correct_answer": "A. Renal cyst", "question_images": ["https://image.prepladder.com/content/nrgGfTNGuzD9EyAesM771724910015.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;Renal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent laparoscopic cholecystectomy. Identify the marked structure in the image.", "options": [{"label": "A", "text": "Cystic artery", "correct": false}, {"label": "B", "text": "Cystic duct", "correct": true}, {"label": "C", "text": "Right hepatic artery", "correct": false}, {"label": "D", "text": "Hepatic duct", "correct": false}], "correct_answer": "B. Cystic duct", "question_images": ["https://image.prepladder.com/notes/ibAGfoY7gaGTNFlmXKY81747644340.png"], "explanation_images": ["https://image.prepladder.com/notes/KPahqe6ko6aSDRZZyiFl1747644427.png", "https://image.prepladder.com/content/tG9s8h10MSHSKcBkQLqq1747294586.png", "https://image.prepladder.com/content/PHrIB311AvYg2M0XXJ6r1747294596.png", "https://image.prepladder.com/notes/WpfsufOtTtvITDM718jf1747644541.png", "https://image.prepladder.com/notes/22pFtWBIqL1Pc0uKeopi1747644589.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old alcoholic patient presents to the ER with severe abdominal pain radiating to the back. Blood investigations reveal increased serum amylase and lipase levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Peptic ulcer disease", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute cholecystitis", "correct": false}, {"label": "D", "text": "Pyogenic liver abscess", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn presents with jaundice. Biliary atresia is suspected when jaundice is persistent and exceeds?", "options": [{"label": "A", "text": "2 days", "correct": false}, {"label": "B", "text": "2 weeks", "correct": true}, {"label": "C", "text": "2 months", "correct": false}, {"label": "D", "text": "2 years", "correct": false}], "correct_answer": "B. 2 weeks", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common complication of ERCP?", "options": [{"label": "A", "text": "Duodenal perforation", "correct": false}, {"label": "B", "text": "Cholangitis", "correct": false}, {"label": "C", "text": "Hemorrhage", "correct": false}, {"label": "D", "text": "Pancreatitis", "correct": true}], "correct_answer": "D. Pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the emergency department with severe abdominal pain radiating to the back. Laboratory investigations reveal elevated serum amylase and lipase levels. Which of the following should be avoided in the management of the given condition?", "options": [{"label": "A", "text": "Nil per oral", "correct": false}, {"label": "B", "text": "Administration of 5% dextrose", "correct": true}, {"label": "C", "text": "Parenteral nutrition", "correct": false}, {"label": "D", "text": "Early initiation of oral feedings", "correct": false}], "correct_answer": "B. Administration of 5% dextrose", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a risk factor for gallbladder cancer?", "options": [{"label": "A", "text": "Porcelain Gall Bladder", "correct": false}, {"label": "B", "text": "Primary Sclerosing Cholangitis", "correct": false}, {"label": "C", "text": "Polyp &amp;lt;10 mm", "correct": true}, {"label": "D", "text": "Gallstone &amp;gt;3 cm", "correct": false}], "correct_answer": "C. Polyp &lt;10 mm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk Factors For <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> GB</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gallstones</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>90% of <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> cases are associated with <strong>gallstones.</strong></li>\n<li>The risk of developing <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> disease is 7-10 times higher than in the general population.</li>\n<li>Relative risk based on stone size:</li>\n<li>Less than 2 cm: Lower risk</li>\n<li>2-3 cm: <span class=\"customMeta\" data-dictid=\"8bbe99007e1692777197cdb196b181\">Relative risk</span> of 2.5</li>\n<li><strong>More than 3 cm (Option D)</strong>: <span class=\"customMeta\" data-dictid=\"8bbe99007e1692777197cdb196b181\">Relative risk</span> of 10 or more</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other Conditions</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Choledochal cyst</li>\n<li>Anomalous <span class=\"customMeta\" data-dictid=\"c2ae5e9c971692777194234dc59b3b\">pancreaticobiliary</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (20%)</li>\n<li><strong>Gallbladder polyps </strong>(more than 1 cm in size, more than 3 in number, or <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyps)</li>\n<li><strong>Porcelain <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> (Option A): </strong>25% risk of <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation, with 90% being <span class=\"customMeta\" data-dictid=\"16690cd26b169277719085df163f96\">inoperable</span> tumours</li>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> Cholangitis</strong> <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infections and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> Conditions</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"f2f6f9068216927772016cacf26183\">typhoid</span> carriers</li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</li>\n<li>Hepatitis B and <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> C virus infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other factors:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Polypoid lesions (GB polyp)</li>\n<li>Xanthogranulomatous cholecystitis</li>\n<li>Nitrosamines</li>\n<li>Carcinogens</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which classification system is used for bile duct injury, taking location, injury to the duct, and vessel involvement into account?", "options": [{"label": "A", "text": "Bismuth", "correct": false}, {"label": "B", "text": "Strasberg", "correct": false}, {"label": "C", "text": "Stewart Way", "correct": false}, {"label": "D", "text": "Hannover", "correct": true}], "correct_answer": "D. Hannover", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xe3AcU1Ylrnwb81vADsV1745927878.png", "https://image.prepladder.com/content/aYkXlwalgLZOd5X8QbAV1745927878.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:534px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bismuth <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> for <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> strictures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> &gt;2cm</li>\n<li>Stricture is Low</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> &lt;2cm</li>\n<li>Stricture is mid<strong> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hilar <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> with intact confluence</li>\n<li>Stricture is high</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hilar <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> with destroyed confluence</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stricture involving <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> with or without <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> of common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> duct</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Type A <strong>(M/C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> leak or leak from sub-vesical <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> of Luschka</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ligation or <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transection without <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of the <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> right sectoral duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type D</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of the Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type E</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E1 to E5 Bismuth classification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent cholecystectomy, and the histopathology reveals carcinoma with invasion into the muscular layer. What is the next best step?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Chemotherapy", "correct": false}, {"label": "C", "text": "Excision of the stump", "correct": false}, {"label": "D", "text": "Extended Cholecystectomy", "correct": true}], "correct_answer": "D. Extended Cholecystectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinoma in situ</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria or muscle layer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades<strong> muscle layer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades perimuscular <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor does not extend to serosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor extends to serosa, but does not invade the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor perforates <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> and/or invades liver/adjacent organs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades main <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein/hepatic artery/multiple <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> organs</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymph node</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastases to 1-3 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastases to &gt;3 regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Choledochal Cyst is incorrect?", "options": [{"label": "A", "text": "Increased risk of cholangiocarcinoma", "correct": false}, {"label": "B", "text": "The cyst can be opened directly and drained", "correct": true}, {"label": "C", "text": "Todani classification is used for grading", "correct": false}, {"label": "D", "text": "Associated with abnormal Bilio-Pancreatic Junction", "correct": false}], "correct_answer": "B. The cyst can be opened directly and drained", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/phEjRvfGBhNPMG96mSUh1745929357.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Todani <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> of Alonso- Lej <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (Most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ib</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fusiform <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diverticular <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilatation of <span class=\"customMeta\" data-dictid=\"977c284355169277719056fe0e0992\">intraduodenal</span> part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (choledochocele)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilatation of both <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> and <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple cysts involving <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type V</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple cysts involving <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> only (Caroli’s disease)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none\">\n<p>Complete excision, cholecystectomy, Roux-en-Y hepaticojejunostomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none\">\n<p>Complete excision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none\">\n<p>Transduodenal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or sphincteroplasty, <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> may suffice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Type IVa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none\">\n<p>Tailored to anatomy: <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> cysts treated like Type I; partial <span class=\"customMeta\" data-dictid=\"bba73f86101692777188a1212603eb\">hepatectomy</span> and <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> for localised <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Type IVb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none\">\n<p>Managed like Type I</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Type V</strong></p>\n<p><strong>(Caroli disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none\">\n<p>Resection for <span class=\"customMeta\" data-dictid=\"7ba13837e7169277720134d37214a8\">unilobar</span> disease; liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents with acute epigastric pain and fever. He has a history of cholelithiasis. On examination, abdominal guarding and rigidity are noted. Laboratory results show elevated serum amylase and lipase levels, along with leukocytosis. What is the most likely diagnosis for his condition?", "options": [{"label": "A", "text": "Serum amylase remains elevated even after 30 days of resolution of acute pancreatitis", "correct": false}, {"label": "B", "text": "&amp;gt; 75 per cent of patients present with hypercalcemia", "correct": false}, {"label": "C", "text": "Serum lipase is more specific than serum amylase", "correct": true}, {"label": "D", "text": "Increase in the level of serum lipase is directly proportional to the severity", "correct": false}], "correct_answer": "C. Serum lipase is more specific than serum amylase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old patient presented with RTA and is brought to ER with a pulse rate of 120/min, and SBP of &amp;lt;80mmHg. Despite intravenous fluid resuscitation and BT, the patient's condition deteriorates with ongoing profuse bleeding from the liver . Identify the procedure shown in the image done to control massive liver bleed.", "options": [{"label": "A", "text": "Kocher maneuver", "correct": false}, {"label": "B", "text": "Pringle’s maneuver", "correct": true}, {"label": "C", "text": "Cattell-Braasch maneuver", "correct": false}, {"label": "D", "text": "Mattox maneuver", "correct": false}], "correct_answer": "B. Pringle’s maneuver", "question_images": ["https://image.prepladder.com/content/mLpkfs26tDRHHbEP5oCd1692686136.jpeg", "https://image.prepladder.com/content/L7JB9TAdDSwWdKIkxvBz1695740045.png"], "explanation_images": [], "explanation": "<p>Correct option B - Pringle's maneuv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which condition is most likely based on the image findings?", "options": [{"label": "A", "text": "Stricture", "correct": false}, {"label": "B", "text": "Choledocholithiasis", "correct": true}, {"label": "C", "text": "Cholecystitis", "correct": false}, {"label": "D", "text": "Cholangiocarcinoma", "correct": false}], "correct_answer": "B. Choledocholithiasis", "question_images": ["https://image.prepladder.com/content/qIpNPBV7LG4OFtl6MBV11745931456.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the sign of the gallbladder seen in this USG?", "options": [{"label": "A", "text": "Phrygian cap sign", "correct": true}, {"label": "B", "text": "Murphy sign", "correct": false}, {"label": "C", "text": "Claw sign", "correct": false}, {"label": "D", "text": "Omega sign", "correct": false}], "correct_answer": "A. Phrygian cap sign", "question_images": ["https://image.prepladder.com/content/utVV3oI48M8AxkGb0qPF1744981656.png"], "explanation_images": ["https://image.prepladder.com/content/NhmFo4C07uzxiE570JLw1744981710.png", "https://image.prepladder.com/content/Y3uhnoB1msCsfWez1lUY1744981717.png", "https://image.prepladder.com/content/XilJNjpq1XKZ6Qa70Hdm1744981726.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After laparoscopic cholecystectomy, what should the expected urine output be in a patient with normal renal function?", "options": [{"label": "A", "text": "500 ml/day", "correct": false}, {"label": "B", "text": "0.5 ml/min", "correct": false}, {"label": "C", "text": "0.5-1.5 ml/kg/hour", "correct": true}, {"label": "D", "text": "1 ml/kg/min", "correct": false}], "correct_answer": "C. 0.5-1.5 ml/kg/hour", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient with a history of dysentery for 6 weeks complains of pain in the right upper abdomen. On ultrasound, a hypoechoic hyperdense lesion is seen in the liver. Based on the given image, identify the condition.", "options": [{"label": "A", "text": "Amoebic liver abscess", "correct": true}, {"label": "B", "text": "Pyogenic liver abscess", "correct": false}, {"label": "C", "text": "Hydatid cyst", "correct": false}, {"label": "D", "text": "Hemangioma", "correct": false}], "correct_answer": "A. Amoebic liver abscess", "question_images": ["https://image.prepladder.com/content/sKavgp9HGUKG08lGikt51745933805.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Amebic Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Pyogenic Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">20–40 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">&gt;50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Male-to-Female Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">≥10:1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">1.5:1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Solitary vs Multiple</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Solitary 80%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Solitary 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Usually right liver</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Usually right liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Travel in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">Endemic</span> Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Uncommon (∼2%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">More common (∼27%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Alcohol Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Elevated Bilirubin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> Phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Positive Blood Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Positive Amebic Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, abdominal pain, and jaundice. Investigations show the given findings. Which of the following statements is true regarding this condition?", "options": [{"label": "A", "text": "Surgery is mandatory", "correct": false}, {"label": "B", "text": "Fine-needle aspiration cytology is diagnostic", "correct": false}, {"label": "C", "text": "Angioembolization is the treatment of choice", "correct": false}, {"label": "D", "text": "Echinococcus species is involved in etiology", "correct": true}], "correct_answer": "D. Echinococcus species is involved in etiology", "question_images": ["https://image.prepladder.com/notes/jKsBpVWDp7r5YlD0fRtp1745916341.png"], "explanation_images": ["https://image.prepladder.com/notes/WNOWUZXmpG0CBPwDTkNr1745916342.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old alcoholic patient presents with sudden and unintentional weight loss. Lab investigations revealed serum alkaline phosphatase (ALP) of 240 IU/L, alpha-fetoprotein (AFP) of 600 ng/ml, and normal serum AST and ALT levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hepatic adenoma", "correct": false}, {"label": "B", "text": "Cholangiocarcinoma", "correct": false}, {"label": "C", "text": "Hepatocellular carcinoma", "correct": true}, {"label": "D", "text": "Alcoholic hepatitis", "correct": false}], "correct_answer": "C. Hepatocellular carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bhWDk3aQowl5I6Zl5rbY1745299917.png", "https://image.prepladder.com/content/OHSUU91g9qh5ukCt9dT61745299917.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cirrhosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Environmental factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HBV infection</li>\n<li>HCV infection</li>\n<li>Alcohol</li>\n<li>NAFLD</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Chronic active hepatitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemochromatosis</li>\n<li>Wilson's Disease</li>\n<li>Glycogen Storage Disorder</li>\n<li>α1AT-deficiency</li>\n<li>Porphyria cutanea tarda</li>\n<li>Citrullinemia</li>\n<li>Orotic aciduria</li>\n<li>Alagille's syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cigarette Smoking</li>\n<li>Anabolic steroids</li>\n<li>Aflatoxin</li>\n<li>Thorotrast</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with features of chronic pancreatitis, including recurrent attacks, and has a 10 mm dilatation of the pancreatic duct with intraductal calculi present. Which of the following is the surgery of choice?", "options": [{"label": "A", "text": "Pancreaticoduodenectomy", "correct": false}, {"label": "B", "text": "Longitudinal pancreaticojejunostomy", "correct": true}, {"label": "C", "text": "ERCP and sphincterotomy", "correct": false}, {"label": "D", "text": "Coring of the pancreas head", "correct": false}], "correct_answer": "B. Longitudinal pancreaticojejunostomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives with pain in the right upper abdomen. One week ago, the patient experienced a bout of diarrhoea. Abdominal CT scan results indicate the presence of a liver abscess measuring approximately 25 cubic centimetres. What should be the subsequent course of action in treating this patient?", "options": [{"label": "A", "text": "PAIR", "correct": false}, {"label": "B", "text": "Surgery", "correct": false}, {"label": "C", "text": "Medical therapy", "correct": true}, {"label": "D", "text": "Percutaneous drainage", "correct": false}], "correct_answer": "C. Medical therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Amebic Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Pyogenic Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>20–40 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>&gt;50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Male-to-Female Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>≥10:1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>1.5:1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Solitary vs Multiple</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Solitary 80%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Solitary 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Usually right liver</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Usually right liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Travel in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">Endemic</span> Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uncommon (∼2%)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>More common (∼27%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Alcohol Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Elevated Bilirubin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> Phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Positive Blood Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Positive Amebic Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best preferred investigation for Neuroendocrine Tumors (NETs)?", "options": [{"label": "A", "text": "USG", "correct": false}, {"label": "B", "text": "SRS", "correct": false}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "PET", "correct": true}], "correct_answer": "D. PET", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic-alcoholic presents to the emergency room with acute pain in the abdomen in the epigastric region radiating to the back with nausea, anorexia, and occasional vomiting. Investigations showed elevated amylase levels (3 times) and total count. Likely diagnosis is:", "options": [{"label": "A", "text": "Acute hepatitis", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute cholecystitis", "correct": false}, {"label": "D", "text": "Acute appendicitis", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0HWNV9cQiO7BTOdSrK8w1746165064.png", "https://image.prepladder.com/content/R1Gzi6QbHXZIaP7jKDN51746165064.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>X-ray Features</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sentinel loop sign</strong>:\n\t\t\t\t<ul>\n<li>Dilated loop of small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> near the inflamed <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> ileus.</li>\n<li><strong>Significance</strong>: Early indicator of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> on X-ray.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohammad Niknejad\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/sentinel-loop-acute-appendicitis-2#image-3004244\" data-tags=\"\" height=\"600\" src=\"https://image.prepladder.com/content/0HWNV9cQiO7BTOdSrK8w1746165064.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Sentinel loop sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Colon cut-off sign</strong>:\n\t\t\t\t<ul>\n<li>Abrupt <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> at the splenic flexure, with collapsed <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> loops.</li>\n<li><strong>Significance</strong>: Suggests <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pancreatic inflammation, causing <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> as an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> pancreatitis</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cerevisae\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Colonic_cut_off_sign_on_chest_X-ray.jpg\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/R1Gzi6QbHXZIaP7jKDN51746165064.png\" width=\"446\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old alcoholic patient presents with a history of waxing and waning jaundice for the past 2 months. His CT examination reveals dilatation of the common bile duct and pancreatic duct. What is the most probable diagnosis in the patient?", "options": [{"label": "A", "text": "Cholangiocarcinoma", "correct": false}, {"label": "B", "text": "Periampullary carcinoma", "correct": true}, {"label": "C", "text": "Common bile duct stone", "correct": false}, {"label": "D", "text": "Head of the pancreas carcinoma", "correct": false}], "correct_answer": "B. Periampullary carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ampullary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periampullary</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They originate in the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They originate in the pancreas, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, or intestines close to the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They have a better survival rate than <span class=\"customMeta\" data-dictid=\"9fab1cb2e416927771950a4f5dfcfd\">periampullary</span> cancers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poorer survival rate.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective technique for procuring tissue for the purpose of diagnosing pancreatic carcinoma?", "options": [{"label": "A", "text": "Transgastric FNAC guided by endoscopic ultrasound", "correct": true}, {"label": "B", "text": "MRI - guided biopsy", "correct": false}, {"label": "C", "text": "Laparoscopic - guided biopsy", "correct": false}, {"label": "D", "text": "Percutaneous transperitoneal biopsy", "correct": false}], "correct_answer": "A. Transgastric FNAC guided by endoscopic ultrasound", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Transgastric FNAC guided by &lt;span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\"&gt;endoscopic&lt;/span&gt; ultrasou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is AFP a tumor marker?", "options": [{"label": "A", "text": "HCC", "correct": true}, {"label": "B", "text": "RCC", "correct": false}, {"label": "C", "text": "Oncocytoma", "correct": false}, {"label": "D", "text": "Chordoma", "correct": false}], "correct_answer": "A. HCC", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - HCC\n<table border=\"1\" style=\"width:692px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Associated Cancers</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>CEA</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Colorectal carcinoma</li>\n<li>Pancreatic carcinoma</li>\n<li>Gastric carcinoma</li>\n<li>Lung carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>PSA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Prostate carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>AFP</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</li>\n<li>Germ cell tumors (e.g., testicular cancer)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>CA125</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Ovarian carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>CA 199</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Pancreatic carcinoma</li>\n<li>Colorectal carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>hCG</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Germ cell tumors (e.g., testicular and ovarian cancer)</li>\n<li>Choriocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>153</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Breast carcinoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cancers rarely metastasizes to the liver ?", "options": [{"label": "A", "text": "Colon", "correct": false}, {"label": "B", "text": "Breast", "correct": false}, {"label": "C", "text": "Prostate", "correct": true}, {"label": "D", "text": "Melanoma", "correct": false}], "correct_answer": "C. Prostate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C -P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old female presents to the clinic with a complaint of recurrent right upper quadrant pain complaint. They exacerbate, especially after eating. An ultrasound of the abdomen is performed, which comes out to be non-conclusive. Which of the following procedures is indicated in the image below?", "options": [{"label": "A", "text": "Percutaneous transhepatic cholangiogram", "correct": false}, {"label": "B", "text": "T-tube cholangiogram", "correct": false}, {"label": "C", "text": "Endoscopic retrograde cholangiopancreatography (ERCP)", "correct": true}, {"label": "D", "text": "Hepatobiliary iminodiacetic acid (HIDA) scan", "correct": false}], "correct_answer": "C. Endoscopic retrograde cholangiopancreatography (ERCP)", "question_images": ["https://image.prepladder.com/content/MS8ezue4EMgROUyBSeac1714386511.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Endoscopic &lt;span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\"&gt;retrograde&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"81439c0f9716927771841fe69eb19e\"&gt;cholangiopancreatography&lt;/span&gt; (ERCP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic patient came to the emergency with pain in the epigastrium radiating to the back and recurrent vomiting . On examination, guarding was present in the upper epigastrium . The erect chest X-ray was normal. What is the next step?", "options": [{"label": "A", "text": "Upper Gl endoscopy", "correct": false}, {"label": "B", "text": "Alcohol breath test", "correct": false}, {"label": "C", "text": "Serum lipase", "correct": true}, {"label": "D", "text": "CECT", "correct": false}], "correct_answer": "C. Serum lipase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Serum lipase: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common neuroendocrine tumor of the pancreas is:", "options": [{"label": "A", "text": "Gastrinoma", "correct": false}, {"label": "B", "text": "Somatostatinoma", "correct": false}, {"label": "C", "text": "Insulinoma", "correct": true}, {"label": "D", "text": "VIPoma", "correct": false}], "correct_answer": "C. Insulinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Insu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of chronic pancreatitis ?", "options": [{"label": "A", "text": "Gallstones", "correct": false}, {"label": "B", "text": "Alcohol", "correct": true}, {"label": "C", "text": "Autoimmune", "correct": false}, {"label": "D", "text": "Drugs", "correct": false}], "correct_answer": "B. Alcohol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Alcoh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What triad is characterized by abdominal pain, fever, and jaundice ?", "options": [{"label": "A", "text": "Saint triad", "correct": false}, {"label": "B", "text": "Charcot’s triad", "correct": true}, {"label": "C", "text": "Virchow triad", "correct": false}, {"label": "D", "text": "Reynold's Pentad", "correct": false}], "correct_answer": "B. Charcot’s triad", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Charcot’\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 32-year-old male, who complained of fever and pain in the upper right abdomen following meals, the recommended diagnostic test is", "options": [{"label": "A", "text": "CECT", "correct": false}, {"label": "B", "text": "USG", "correct": true}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "HRCT", "correct": false}], "correct_answer": "B. USG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - USG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man is brought to the casualty with severe abdominal pain radiating to the back for the past 1 day and has had 3 episodes of vomiting. The pain radiates to the back and is slightly relieved in the sitting forward position . The following signs are seen on examination and lab investigations reveal elevated lipase and amylase . Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute appendicitis", "correct": false}, {"label": "B", "text": "Acute cholecystitis", "correct": false}, {"label": "C", "text": "Acute pancreatitis", "correct": true}, {"label": "D", "text": "Acute ischemic colitis", "correct": false}], "correct_answer": "C. Acute pancreatitis", "question_images": ["https://image.prepladder.com/content/ONMUZahNXR5qg0eHKLsM1714385920.png"], "explanation_images": ["https://image.prepladder.com/content/5Y5cbOZ6tOHxE4LEuKNg1698038867.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the optimal management approach for a patient presenting with fever and abdominal pain five days after experiencing a common bile duct injury resulting in a leak ?", "options": [{"label": "A", "text": "Ultrasound–guided aspiration", "correct": false}, {"label": "B", "text": "ERCP and stenting", "correct": true}, {"label": "C", "text": "Re-exploration and hepaticojejunostomy", "correct": false}, {"label": "D", "text": "Re-exploration and primary repair", "correct": false}], "correct_answer": "B. ERCP and stenting", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b2276d3d4c16927771872281723792\"&gt;ERCP&lt;/span&gt; and stenting\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following represents a type III choledochal cyst from the given image ?", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "C", "correct": true}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "C. C", "question_images": ["https://image.prepladder.com/content/0Xb4r6O9pUM0DZ10gu2a1685078127.png"], "explanation_images": ["https://image.prepladder.com/content/KhPk5zNJKcJCCKJpPWfZ1714383857.png"], "explanation": "<p>Correct Option C - C\n<table>\n<tbody>\n<tr>\n<td colspan=\"3\">\n<p style=\"text-align:center\"><strong>Todani <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">Modification</span> of ALONSO-LEJ Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"3\">\n<p><strong>Type I</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<p><strong>I a</strong></p>\n</td>\n<td>\n<p>Cystic <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (most common)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>II b</strong></p>\n</td>\n<td>\n<p>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>I c</strong></p>\n</td>\n<td>\n<p>Fusiform <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Type II</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p>Diverticular dilataion of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Type III</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p>Dilatation of <span class=\"customMeta\" data-dictid=\"977c284355169277719056fe0e0992\">intraduodenal</span> part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (choledochocele)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\">\n<p><strong>Type IV</strong></p>\n</td>\n<td>\n<p><strong>IV a</strong></p>\n</td>\n<td>\n<p>Dilatation of both <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> and <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>IV b</strong></p>\n</td>\n<td>\n<p>Multiple cysts involving <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> only</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Type V</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p>Multiple cysts involving only <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (Caroli's disease)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which neuroendocrine tumor of the pancreas is commonly linked with necrolytic erythema migrans ?", "options": [{"label": "A", "text": "Insulinoma", "correct": false}, {"label": "B", "text": "Glucagonoma", "correct": true}, {"label": "C", "text": "Somatostatinoma", "correct": false}, {"label": "D", "text": "VIPoma", "correct": false}], "correct_answer": "B. Glucagonoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/C1Aqn4eTnzvRIW0SK1oz1714383905.png"], "explanation": "<p>Correct Option B - Glucag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 80 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements is not true regarding deep vein thrombosis (DVT)?", "options": [{"label": "A", "text": "Clinical assessment is unreliable", "correct": false}, {"label": "B", "text": "Mostly bilateral", "correct": true}, {"label": "C", "text": "Most common clinical presentation is pain and tenderness in calf", "correct": false}, {"label": "D", "text": "Some cases may directly present as pulmonary thromboembolism", "correct": false}], "correct_answer": "B. Mostly bilateral", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the CEAP stage of clinical classification for chronic venous disorders in a truck driver who has dilated, tortuous veins measuring 4 mm in the foot?", "options": [{"label": "A", "text": "C0", "correct": false}, {"label": "B", "text": "C1", "correct": false}, {"label": "C", "text": "C2", "correct": true}, {"label": "D", "text": "C3", "correct": false}], "correct_answer": "C. C2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 12 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the given instrument.", "options": [{"label": "A", "text": "Veress needle", "correct": true}, {"label": "B", "text": "Hasson's cannula", "correct": false}, {"label": "C", "text": "Jamshidi needle", "correct": false}, {"label": "D", "text": "3 mm Trocar", "correct": false}], "correct_answer": "A. Veress needle", "question_images": ["https://image.prepladder.com/content/C1gY2W6LEluDhcPuVqK81741108912.png"], "explanation_images": ["https://image.prepladder.com/content/ZHbblWdREHDVZXKlV4201741108932.png", "https://image.prepladder.com/content/mLgIqP5CtUHgpcAjsK4T1741069125.png", "https://image.prepladder.com/content/AhVvenpxAlOSG9Eyrxeg1741069144.png", "https://image.prepladder.com/content/aEOWFP9nAbqHWYIm3wMM1741108962.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:402px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creates <span class=\"customMeta\" data-dictid=\"8c36ab9b0516927771962c88c4ada4\">pneumoperitoneum</span> for laparoscopy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spring-loaded <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> <span class=\"customMeta\" data-dictid=\"a1244e4821169277719985dd460729\">stylet</span> for safety</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insertion Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly at the umbilicus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hasson’s open technique</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Artificial creation of gas <span class=\"customMeta\" data-dictid=\"0bb08aec621692777190d80a74d35c\">insufflation</span> in the peritoneal <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to facilitate <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Gas Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carbon <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (CO₂) due to its rapid absorption, non-combustibility, and high <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> in blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closed technique</strong>: Uses <span class=\"customMeta\" data-dictid=\"4726929e261692777201a665a56fa7\">Veress needle</span> for insufflation.</p>\n<p><strong>Open technique</strong>: Uses Hasson’s <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> without prior insufflation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insufflation Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 mmHg (optimal for maintaining <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> space while minimizing complications).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gas-related</strong>: Hypercapnia, acidosis, gas embolism.</p>\n<p><strong>Entry-related</strong>: <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> injury, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury, <span class=\"customMeta\" data-dictid=\"707b8e89cd1692777196474be04ff0\">preperitoneal</span> insufflation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention of Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correct needle placement confirmation (aspiration test, <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> drop test).</p>\n<p>Slow controlled insufflation.</p>\n<p>Monitoring <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO₂ levels.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Calculate the area of burn.", "options": [{"label": "A", "text": "5-10%", "correct": false}, {"label": "B", "text": "20-30%", "correct": false}, {"label": "C", "text": "10-15%", "correct": false}, {"label": "D", "text": "40-50%", "correct": true}], "correct_answer": "D. 40-50%", "question_images": ["https://image.prepladder.com/content/mggNti9SMWSMEA1pLy6G1741111356.png"], "explanation_images": ["https://image.prepladder.com/content/zwP5xDskgAhOfnkVFrak1741069571.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure?", "options": [{"label": "A", "text": "Retrograde pyelogram", "correct": false}, {"label": "B", "text": "Combined Retrograde Pyelogram and Ureteroscopy", "correct": false}, {"label": "C", "text": "Intravenous Pyelogram", "correct": true}, {"label": "D", "text": "Antegrade pyelography", "correct": false}], "correct_answer": "C. Intravenous Pyelogram", "question_images": ["https://image.prepladder.com/content/RLJF5y2jpRv0a8KGdEcp1741111710.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (IVP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV contrast injection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspected <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> obstruction, nephrolithiasis, tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast seen in kidneys, ureters, and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> on sequential films</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrograde <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (RGP) </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> via <span class=\"customMeta\" data-dictid=\"3ee67fc1971692777185b21b950a61\">cystoscopy</span> into ureters</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspected ureteral obstruction, non-visualization on IVP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast opacifies the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> without nephrogram</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antegrade <span class=\"customMeta\" data-dictid=\"aabbf4882c169277719601141cd424\">Pyelography</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> percutaneously into the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction, post-surgical assessment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast fills <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and ureters from above</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combined RGP &amp; <span class=\"customMeta\" data-dictid=\"aba89fa6131692777201043967a365\">Ureteroscopy</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteroscope inserted via <span class=\"customMeta\" data-dictid=\"3ee67fc1971692777185b21b950a61\">cystoscopy</span> + contrast study</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteric stones, strictures, or tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> along with contrast study</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not related to disease progression?", "options": [{"label": "A", "text": "Duration", "correct": true}, {"label": "B", "text": "Depth", "correct": false}, {"label": "C", "text": "Site", "correct": false}, {"label": "D", "text": "Stage of Cancer", "correct": false}], "correct_answer": "A. Duration", "question_images": ["https://image.prepladder.com/content/oZEgru0yYh1xXnXke3qR1741106706.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect on Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deeper invasion into muscle, cartilage, or bone increases severity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-risk sites (face, scalp, ears) have more aggressive behavior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Later stages indicate increased tumor burden and invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow growth means duration does not directly impact aggressiveness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 14 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the surgical instrument depicted in the provided image.", "options": [{"label": "A", "text": "Mixter Forceps", "correct": true}, {"label": "B", "text": "Rampley Forceps", "correct": false}, {"label": "C", "text": "Kocher Forceps", "correct": false}, {"label": "D", "text": "Adson Forceps", "correct": false}], "correct_answer": "A. Mixter Forceps", "question_images": ["https://image.prepladder.com/content/N9W4rOyljstx82uuspc21745932697.png"], "explanation_images": ["https://image.prepladder.com/content/j7xEz9QJls97VhH6gzY11745212141.png", "https://image.prepladder.com/content/DPUoQttnEj15w3D2XkTr1745212148.png", "https://image.prepladder.com/content/opnbBAYvPAzQMlpAq1Sx1745212155.png", "https://image.prepladder.com/content/vOWEqGTtLdKqbIghqJxj1745932836.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rampley's <span class=\"customMeta\" data-dictid=\"1f8d123d5a16927771996d6f75145f\">Sponge</span> Holding Forceps</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"410\" src=\"https://image.prepladder.com/content/j7xEz9QJls97VhH6gzY11745212141.png\" width=\"410\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Designed in a scissor-like configuration, featuring ratcheted handles with <strong>serrated looped jaws</strong>.</li>\n<li>Used to handle <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> or sponges.</li>\n<li>Used to hold <span class=\"customMeta\" data-dictid=\"bec5d0b8cb1692777188267d64974a\">gall</span> bladder/cervix/tongue etc., during <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> procedures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kocher’s Forceps</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Josephine Bitat\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pince_Kocher_-_mus%C3%A9e_HCL_-_instruments_chirurgicaux.jpg\" data-tags=\"\" height=\"232\" src=\"https://image.prepladder.com/content/DPUoQttnEj15w3D2XkTr1745212148.png\" width=\"410\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serrations in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> blades with an opposing tooth at the tip.</li>\n<li>Holds tissues or pedicles securely, preventing slippage and <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> of vessels or bleeders.</li>\n<li>Types:\n\t\t\t\t<ul>\n<li>Straight/Curved.</li>\n<li>Small/medium/large.</li>\n</ul>\n</li>\n<li>Used in <strong>thyroidectomy, hemorrhoidectomy, mastectomy, polypectomy, and hysterectomy</strong>.</li>\n<li>Used to secure tough or <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissues in areas like the palms, soles, and <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> to prevent vessel <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> during surgery.</li>\n<li>Holds <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> and <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> pellets.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toothed Forceps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"410\" src=\"https://image.prepladder.com/content/opnbBAYvPAzQMlpAq1Sx1745212155.png\" width=\"410\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to hold skin and tough structures like <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and aponeurosis.</li>\n<li>Not used for delicate structures like the bowel, vessels, or nerves.</li>\n<li>May have one-in-two or two-in-three teeth.</li>\n<li><strong>Adson’s <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">Forceps</span> </strong><strong>(Option D)</strong>: Small, fine <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> for delicate work; can be toothed or non-toothed.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"744\" src=\"https://image.prepladder.com/content/vOWEqGTtLdKqbIghqJxj1745932836.png\" width=\"1999\"/></p>\n<p> </p>\n<ul>\n<li><strong>Victor–Bonney’s Forceps</strong>: Heavy-toothed dissecting forceps.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the instrument provided.", "options": [{"label": "A", "text": "Linear stapler", "correct": true}, {"label": "B", "text": "Skin stapler", "correct": false}, {"label": "C", "text": "Circular stapler", "correct": false}, {"label": "D", "text": "Curved stapler", "correct": false}], "correct_answer": "A. Linear stapler", "question_images": ["https://image.prepladder.com/notes/xdAzI44TSejZQig9VzH61747400843.png"], "explanation_images": ["https://image.prepladder.com/notes/e9Hts3IplcbamH3gvf3Q1747382931.png", "https://image.prepladder.com/notes/ys81WcK211qGlSNSDx1Q1747383038.png", "https://image.prepladder.com/notes/NiT9wjanz88th8kiFYwQ1747407757.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are used to stop oesophagal variceal bleeding?", "options": [{"label": "A", "text": "A, B &amp;amp; C", "correct": true}, {"label": "B", "text": "A and B only", "correct": false}, {"label": "C", "text": "A, Band C", "correct": false}, {"label": "D", "text": "A, B and D", "correct": false}], "correct_answer": "A. A, B &amp; C", "question_images": ["https://image.prepladder.com/notes/P8XI59f8YDLmEHwJoDa41746518124.png"], "explanation_images": ["https://image.prepladder.com/notes/OH0zdarcbW7eghN8WlkP1746518275.png", "https://image.prepladder.com/notes/gpgzVXqTdDtBFimBX5hi1746518302.png", "https://image.prepladder.com/notes/0kO3dRU25atHMnqR4Dc71746518329.png", "https://image.prepladder.com/notes/ZDPs59o2KHn84OjK8h0y1746518359.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 13 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements is TRUE? The most commonly injured organ in blunt trauma to the abdomen is the liver. The liver is the most commonly injured organ in penetrating abdominal trauma. In gunshot injuries to the abdomen, the stomach is the most commonly injured organ. The jejunum is the most commonly injured part of the bowel in blunt trauma to the abdomen. The mesentery is the most commonly injured structure in seat belt injuries. The first investigation done on a patient with blunt abdominal trauma is a CT scan. CECT is the investigation of choice for a stable patient with blunt abdominal trauma.", "options": [{"label": "A", "text": "1, 2, 3, 6, 7", "correct": false}, {"label": "B", "text": "3, 4, 5, 6", "correct": false}, {"label": "C", "text": "2, 4, 5, 7", "correct": true}, {"label": "D", "text": "1, 2, 5, 7", "correct": false}], "correct_answer": "C. 2, 4, 5, 7", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dKB23kCidvTANKGG2meI1744890150.mp3", "video": ""}, {"text": "A 30 y/o male is admitted after a motorcycle accident with abdominal trauma. The doctor decides to perform initial imaging tests. Which statement about FAST, eFAST, and DPL is incorrect?", "options": [{"label": "A", "text": "eFAST can detect &amp;gt;100 mL of free blood in the abdomen and thoracic cavities.", "correct": false}, {"label": "B", "text": "FAST is reliable for assessing retroperitoneum and detecting injuries to hollow viscus.", "correct": true}, {"label": "C", "text": "DPL is valuable in resource-limited settings and detects blood or contaminants in the abdomen.", "correct": false}, {"label": "D", "text": "FAST and eFAST do not determine the specific nature or extent of injuries.", "correct": false}], "correct_answer": "B. FAST is reliable for assessing retroperitoneum and detecting injuries to hollow viscus.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/P0FXYesYiyb137XMXGJN1739279216.png", "https://image.prepladder.com/content/rLMqxcOxR0GZp3Y7YLiU1739279368.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SHWqJdlrzZEgaHLnj5Hm1744890665.mp3", "video": ""}, {"text": "Which of the following is the most accurate diagnostic tool for evaluating blunt abdominal trauma in a hemodynamically stable patient?", "options": [{"label": "A", "text": "FAST (Focused Assessment with Sonography for Trauma)", "correct": false}, {"label": "B", "text": "Diagnostic Peritoneal Lavage (DPL)", "correct": false}, {"label": "C", "text": "CT scan with IV contrast", "correct": true}, {"label": "D", "text": "Plain abdominal X-ray", "correct": false}], "correct_answer": "C. CT scan with IV contrast", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IkTms6EMWCM9gpax525X1739280918.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HXcmcIK7S27OZcWUakwj1744891088.mp3", "video": ""}, {"text": "A 34 y/o man presents with a gunshot wound to the abdomen. He is hemodynamically unstable with a blood pressure of 90/60 mmHg and a heart rate of 130 bpm. On examination, there is significant abdominal tenderness with guarding and rigidity. What is the best initial management step?", "options": [{"label": "A", "text": "Perform a FAST scan", "correct": false}, {"label": "B", "text": "Start fluid resuscitation and obtain an abdominal X-ray", "correct": false}, {"label": "C", "text": "Urgent exploratory laparotomy", "correct": true}, {"label": "D", "text": "Obtain a CT scan with IV contrast", "correct": false}], "correct_answer": "C. Urgent exploratory laparotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SbaaoYOReZlGNOJmPUlh1739281194.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TedeUudABj1AZ3t9Ut6w1744891316.mp3", "video": ""}, {"text": "A 35 y/o male presents to the emergency following a motor vehicle accident. He is hemodynamically stable with left upper quadrant tenderness. A FAST exam reveals free fluid in the abdomen. The CT scan shows a minor splenic injury. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Immediate splenectomy", "correct": false}, {"label": "B", "text": "Non-operative management with close monitoring in ICU", "correct": true}, {"label": "C", "text": "Exploratory laparotomy", "correct": false}, {"label": "D", "text": "Angiography with embolization", "correct": false}], "correct_answer": "B. Non-operative management with close monitoring in ICU", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>American Association for the Surgery of Trauma - AAST <span class=\"customMeta\" data-dictid=\"6a4861c8d71692777199aeb1d55c85\">Spleen</span> Injury scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I (Minor Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> affects less than 10% of the splenic surface area.</li>\n<li>Capsular tear that is less than 1 cm in depth without active bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-50% of the splenic surface area.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> less than 5 cm in diameter.</li>\n<li>Laceration between 1 and 3 cm in depth that doesn't involve trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covering more than 50% of the splenic surface area or expanding hematoma.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> greater than 5 cm or expanding.</li>\n<li>Laceration more than 3 cm in depth or involving trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laceration affects <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> or hilar vessels, with evidence of <span class=\"customMeta\" data-dictid=\"ddadff81201692777186bff3a36612\">devascularization</span> involving more than 25% of the spleen.</li>\n<li>Injury to the splenic <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> that results in major blood loss.</li>\n<li>Any injury in the presence of splenic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury or active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> within the splenic capsule</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade V (Severe Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Completely shattered spleen.</li>\n<li>Vascular injury involving the splenic <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> that results in complete <span class=\"customMeta\" data-dictid=\"ddadff81201692777186bff3a36612\">devascularization</span> of the spleen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rqeqrmpsK4UWangIPUYB1744891729.mp3", "video": ""}, {"text": "During liver trauma surgery, the Pringle manoeuvre is performed to control bleeding. Which of the following structures is occluded during this manoeuvre?", "options": [{"label": "A", "text": "Hepatic artery", "correct": false}, {"label": "B", "text": "Portal vein", "correct": false}, {"label": "C", "text": "Both the hepatic artery and portal vein", "correct": true}, {"label": "D", "text": "Bile duct", "correct": false}], "correct_answer": "C. Both the hepatic artery and portal vein", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nVI8NYsWRALj9hpwe8YR1740108640.png", "https://image.prepladder.com/content/yo2uQ5t1Cv2hEaJpUDOK1739283008.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A</strong><strong>merican Association for the Surgery of Trauma - AAST Liver Injury scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I (Minor Injury)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covers less than 10% of the liver surface area.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> of less than 1 cm deep without significant parenchymal disruption.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covering 10-50% of the liver surface area.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> less than 10 cm in diameter.</li>\n<li>Laceration between 1-3 cm deep and less than 10 cm in length.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covers more than 50% of the liver surface area or ruptured hematoma.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> greater than 10 cm</li>\n<li>Laceration deeper than 3 cm.</li>\n<li>Vascular injury with active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> contained within liver parenchyma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parenchymal <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> involving 25-75% of a <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> or affecting 1-3 liver segments.</li>\n<li>Active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> extends beyond the liver into the peritoneal cavity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade V (Severe Injury)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parenchymal <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> affects more than 75% of the <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> lobe.</li>\n<li>Major <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injuries, such as those involving the retrohepatic <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> or central <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> veins.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MC8hioQydmhukEqVnA8O1744891958.mp3", "video": ""}, {"text": "A 40 y/o male presents to the emergency after a high-speed motorcycle collision. He is hemodynamically stable but reports severe, diffuse abdominal pain. On examination, there is significant tenderness in the upper abdomen, but no guarding or rebound tenderness is noted. Which of the following findings on the CT scan would most strongly suggest a duodenal injury?", "options": [{"label": "A", "text": "Free air in the retroperitoneum", "correct": true}, {"label": "B", "text": "Liver laceration with intra-abdominal free fluid", "correct": false}, {"label": "C", "text": "Large splenic hematoma with peri splenic fluid collection", "correct": false}, {"label": "D", "text": "Moderate free fluid in the pelvis without solid organ injury", "correct": false}], "correct_answer": "A. Free air in the retroperitoneum", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5IXWJMKLKcd4uZBq1Mle1744892033.mp3", "video": ""}, {"text": "A 28 y/o male suffers a stab wound to the abdomen. During surgery, an injury to the head of the pancreas is discovered, with the involvement of both the main pancreatic duct and the intrapancreatic bile duct. Which surgical procedure is most appropriate for this injury?", "options": [{"label": "A", "text": "Distal pancreatectomy", "correct": false}, {"label": "B", "text": "Whipple procedure", "correct": true}, {"label": "C", "text": "External drainage alone", "correct": false}, {"label": "D", "text": "Repair of the pancreatic duct without resection", "correct": false}], "correct_answer": "B. Whipple procedure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SaYCB6hsiiO9xjU3fjwH1739332476.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AAST Pancreatic Injury Grading</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor bruising or a <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> tear of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> without involving the ductal system.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant bruising or a <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> of the pancreas, without ductal injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe injury involving a deep tear or complete <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end of the pancreas, with damage to the ductal system.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensive injury at the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> end of the pancreas, involving a deep tear or <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> that affects the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> and/or the <span class=\"customMeta\" data-dictid=\"e2d64c20f016927771901434cfb74f\">intrapancreatic</span> portion of the common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensive damage to the pancreatic head results in a severely fragmented or \"shattered\" pancreas.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WosnN0kmsgSXXU2snHOH1744892191.mp3", "video": ""}, {"text": "A 29 y/o male presents to the emergency following a high-speed car crash. He was wearing a seat belt and had a clear seat belt sign across his lower abdomen. He reports increasing abdominal pain and tenderness. Which structure is commonly injured in this scenario?", "options": [{"label": "A", "text": "Mesentery", "correct": true}, {"label": "B", "text": "Liver", "correct": false}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Bladder", "correct": false}], "correct_answer": "A. Mesentery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dLvl1w55vA5FxEtiNStk1740109305.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MWhK9d0HzwjSWbfxQNTG1744892468.mp3", "video": ""}, {"text": "A 45 y/o male is undergoing damage control surgery after sustaining severe abdominal injuries in a construction accident. After rapid haemorrhage control, he is moved to the ICU for further resuscitation. What is the main focus during the ICU stage of damage control surgery?", "options": [{"label": "A", "text": "Definitive Closure of the Abdomen", "correct": false}, {"label": "B", "text": "Ongoing Resuscitation and Stabilization", "correct": true}, {"label": "C", "text": "Repair of Organ Injuries", "correct": false}, {"label": "D", "text": "Selection of the Next Surgical Procedure", "correct": false}], "correct_answer": "B. Ongoing Resuscitation and Stabilization", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:491px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages of Damage Control Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intervention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient Selection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Control of haemorrhage and contamination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resuscitation in ICU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive Surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdomen closure</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phases of Damage Control Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognition and Decision-making</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intubation, early rewarming, and prompt movement to operation theatre</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate Laparotomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Control of bleeding, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> packing, and temporary <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> closure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intensive Care Unit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ongoing <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> and <span class=\"customMeta\" data-dictid=\"eb61b60d6c1692777193b647e170f8\">normalization</span> of <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> and biochemical parameters <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Re-Exploration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive repair of all injuries <strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Kg0jz3AJVBzNUSsLfPL81744892666.mp3", "video": ""}, {"text": "A 45 y/o male patient presents with abdominal distension, decreased urine output, and difficulty breathing following abdominal surgery. His intra-abdominal pressure (IAP) is measured at 28 cm H₂O. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Close monitoring in the ICU", "correct": false}, {"label": "B", "text": "Aggressive fluid resuscitation", "correct": false}, {"label": "C", "text": "Surgical decompression", "correct": true}, {"label": "D", "text": "Administration of diuretics", "correct": false}], "correct_answer": "C. Surgical decompression", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Burch Grading System of <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">Intra-abdominal</span> Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure (cm of H</strong><strong><sub>2</sub></strong><strong>O)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure (mm Hg)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It does not require decompression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16-25</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16-20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Close monitoring <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>26-35</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>21-25</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most require decompression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;35</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;25</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All require immediate decompression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bHtPw3quCTRnfpDBduDQ1744892839.mp3", "video": ""}, {"text": "A 40 y/o male presents to the ER after being involved in a motorcycle collision. His vital signs are stable, and a CT scan reveals an expanding hematoma confined to the lateral retroperitoneum with no active bleeding. What is the most appropriate management approach for this patient?", "options": [{"label": "A", "text": "Immediate surgical exploration", "correct": false}, {"label": "B", "text": "Extraperitoneal packing", "correct": false}, {"label": "C", "text": "Diagnostic peritoneal lavage (DPL)", "correct": false}, {"label": "D", "text": "Angioembolization", "correct": true}], "correct_answer": "D. Angioembolization", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xo4W2Im9BJryKXmdNabd1744893019.mp3", "video": ""}, {"text": "A 35 y/o male presents to the ER after a high-speed motor vehicle accident. He is hemodynamically stable but complains of left-sided abdominal pain. He has hematuria &amp;amp; his CECT shows a 3 cm laceration extending into the renal cortex and medulla without involvement of the collecting system. No evidence of vascular injury is noted. What is the most appropriate grade of renal trauma based on the findings?", "options": [{"label": "A", "text": "Grade I Renal Trauma", "correct": false}, {"label": "B", "text": "Grade II Renal Trauma", "correct": false}, {"label": "C", "text": "Grade III Renal Trauma", "correct": true}, {"label": "D", "text": "Grade IV Renal Trauma", "correct": false}], "correct_answer": "C. Grade III Renal Trauma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dZPNLKzFzwhvDm5rYxOe1740109570.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>AAST GRADING OF <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">RENAL</span> TRAUMA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> and/or parenchymal <span class=\"customMeta\" data-dictid=\"87fe0f103316927771851931d55a3a\">contusion</span> without laceration. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Perirenal hematoma.</li>\n<li>Laceration &lt; 1 cm deep without <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> extravasation. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Laceration &gt; 1 cm deep or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"af0f51214e16927771952526edf6bc\">pedicle</span> injury without <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"f0c6fefae41692777187c76a6f65f6\">extravasation</span> or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Parenchymal <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> extends into the collecting system with <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> extravasation.</li>\n<li>Segmental <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> or <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Grade V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Main <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> or <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">avulsion</span> of the hilum.</li>\n<li>Completely <strong>shattered kidney</strong> or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> avulsion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bkKvNTgZnDiHGFdlwA431744893197.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "During a laparoscopic intra-abdominal surgery, the surgeon has to insufflate the peritoneal cavity. Which of the following statements is true regarding the Veress needle technique?", "options": [{"label": "A", "text": "It is an open technique for creating pneumoperitoneum", "correct": false}, {"label": "B", "text": "The positioning of the needle is confirmed by a laparoscopic camera", "correct": false}, {"label": "C", "text": "Veress needle is a spring-loaded needle", "correct": true}, {"label": "D", "text": "It has a sharp inner stylet that deploys in the peritoneal cavity", "correct": false}], "correct_answer": "C. Veress needle is a spring-loaded needle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZteZtfsjTXnQa3noVesZ1739959350.png", "https://image.prepladder.com/content/1JN5ninIhImttni9RkA71739959363.png", "https://image.prepladder.com/content/LrGJWKLkG7vLqXFucS2W1739959381.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Closed technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Open technique </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Veress needle and/or visual entry <span class=\"customMeta\" data-dictid=\"926ccfdbd8169277720055492d19e0\">trocar</span> </strong><strong>(Option A)</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"4726929e261692777201a665a56fa7\">Veress needle</span> is a <strong>spring-loaded needle</strong><strong> (Option C)</strong>. It has:\n\t\t\t\t<ul>\n<li>An outer sharp <span class=\"customMeta\" data-dictid=\"bbf8b48b88169277718291fbdbac47\">bevel</span> that cuts.</li>\n<li>A <strong>spring-loaded blunt</strong> inner <strong>stylet</strong> <strong> </strong><strong>(Option D)</strong><strong> </strong>deploys once it enters the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> and protects from injuries to the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> and vessels.</li>\n</ul>\n</li>\n<li>Inserted at the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> region or other sites like Palmer’s point.</li>\n<li>Once position is confirmed (by the <strong>hanging drop method </strong>or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pressure reading of &lt;10mmHg), CO2 <span class=\"customMeta\" data-dictid=\"0bb08aec621692777190d80a74d35c\">insufflation</span> is started slowly until a pressure of 12-15mmHg is reached.</li>\n<li>The needle is then removed, and an <span class=\"customMeta\" data-dictid=\"39020a9ff61692777194d4aca09c3b\">optical</span> primary port is placed.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Veress needle:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/ZteZtfsjTXnQa3noVesZ1739959350.png\" width=\"4168\"/></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hasson’s or modified Hasson’s </strong></li>\n<li>Umbilicus is the preferred site for a 10-12mm initial port placement.</li>\n<li>A blunt-tipped 10 to 12-mm <span class=\"customMeta\" data-dictid=\"926ccfdbd8169277720055492d19e0\">trocar</span> is pushed through an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> made through the <span class=\"customMeta\" data-dictid=\"3dfb76e26c16927771855c6df807b9\">decussation</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to the <span class=\"customMeta\" data-dictid=\"c8e3ddf15b1692777184c4fc13f5bb\">cicatrix</span> of the umbilicus.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> camera is used to confirm the successful placement.<strong> </strong><strong>(Option B)</strong></li>\n<li>Then <strong>CO2 </strong>gas <span class=\"customMeta\" data-dictid=\"0bb08aec621692777190d80a74d35c\">insufflation</span> is started at low flow<strong> (1-4 litres per minute)</strong></li>\n<li>Increased to a maximum pressure of <strong>15 mmHg </strong>with a maximum flow rate of <strong>20L/min</strong>.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Trocar: </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/1JN5ninIhImttni9RkA71739959363.png\" width=\"4167\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GbNIn22LV2D4d7ieuZKx1749051691.mp3", "video": ""}, {"text": "A patient who has undergone gastric banding is being advised on postoperative nutritional guidelines. Which of the following supplements is specifically recommended for this patient to prevent deficiency?", "options": [{"label": "A", "text": "Selenium", "correct": false}, {"label": "B", "text": "Folic acid", "correct": false}, {"label": "C", "text": "Zinc", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": true}], "correct_answer": "D. Vitamin D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:591px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>After <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> banding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multivitamin</li>\n<li>Mineral supplement</li>\n<li>Thiamine if vomiting</li>\n<li>Vitamin D <strong>(Option D)</strong></li>\n<li>Iron.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>After sleeve gastrectomy, forms of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> bypass, biliopancreatic diversion/duodenal switch (BPD/DS), single-anastomosis duodenoileal <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> with sleeve <span class=\"customMeta\" data-dictid=\"60e93bf2cd169277718880e1f2920b\">gastrectomy</span> (SADI-S)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>As for <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"14a6f814ea1692777182619ddd636c\">banding</span> +</p>\n<ul>\n<li>Selenium <strong>(Option A)</strong></li>\n<li>Copper</li>\n<li>Zinc <strong>(Option C)</strong></li>\n<li>Folic acid <strong>(Option B)</strong></li>\n<li>Vitamins B12, A, E, K.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>(BPD/DS, SADI-S may require higher doses)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IcOEbPCYfgGfFn8JIGHl1749105836.mp3", "video": ""}, {"text": "A 45-year-old patient undergoes bariatric surgery and is at risk for postoperative complications. What is the most common cause of 30-day mortality following bariatric surgery?", "options": [{"label": "A", "text": "Cardiac failure", "correct": false}, {"label": "B", "text": "Pulmonary embolism", "correct": true}, {"label": "C", "text": "Anastomotic leak", "correct": false}, {"label": "D", "text": "Respiratory failure", "correct": false}], "correct_answer": "B. Pulmonary embolism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:551px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overall mortality rates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perioperative mortality for <span class=\"customMeta\" data-dictid=\"a9d3b38ddb16927771824feedb7ff9\">bariatric</span> surgery is low (&lt;0.5%) and declining but can reach 2.0% or higher in some patient groups.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common causes of 30-day mortality after <span class=\"customMeta\" data-dictid=\"a9d3b38ddb16927771824feedb7ff9\">bariatric</span> surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (38%) <strong>(Option B)</strong></li>\n<li>Cardiac failure (18%) <strong>(Option A)</strong></li>\n<li>Anastomotic leak (18%) <strong>(Option C)</strong></li>\n<li>Respiratory failure (12%) <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most dreaded complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anastomotic leak with overall <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> of 61% and mortality of 15%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maximum risk of anastomotic leak </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrojejunal <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> (60-80%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comparison across procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mortality rates for <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> procedures were reported as:</li>\n<li>Laparoscopic adjustable <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> banding: 0.06%,</li>\n<li>Vertical band gastroplasty: 0.21%,</li>\n<li>Roux-en-Y <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> bypass: 0.16%,</li>\n<li>Biliopancreatic <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> with duodenal switch: 1.11%.</li>\n<li>Higher mortality rates were found for open procedures compared to <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> ones.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/C9FYFutPnSp7lNOmBt2B1749105719.mp3", "video": ""}, {"text": "A 45-year-old patient with a BMI of 38 kg/m² is considering weight loss surgery. The surgeon suggests a procedure that involves placing a band around the stomach just below the cardia to create a small gastric pouch. Which procedure is being recommended?", "options": [{"label": "A", "text": "Sleeve gastrectomy", "correct": false}, {"label": "B", "text": "Roux-en-Y gastric bypass", "correct": false}, {"label": "C", "text": "Intragastric balloon placement", "correct": false}, {"label": "D", "text": "Laparoscopic adjustable gastric banding", "correct": true}], "correct_answer": "D. Laparoscopic adjustable gastric banding", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bsD08AjTBcuUqXJrzj591739960077.png", "https://image.prepladder.com/content/Xzm9Cw5wAnjhscKmkI9K1739960159.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Popularity decline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to long-term results and alternatives.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uses the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> flaccida technique through the window of the lesser omentum.</li>\n<li><strong>Band Placement: </strong>Positioned just below the <span class=\"customMeta\" data-dictid=\"eedaf7d1db169277718739bd40e5c5\">esophagogastric</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> to create a small virtual <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> pouch.</li>\n<li><strong>Band Fixation: </strong>Sutured anteriorly with gastrogastric tunneling sutures to prevent slippage.</li>\n<li><strong>Access Port: </strong>Sutured to the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> in the upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> for easy access by a non-coring, Huber needle for adjustments.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of adjustable bands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lapband (silicon)</li>\n<li>SAGB</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Xopusmagnumx\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Adjustable_gastric_band#/media/File:Adjustable_Gastric_Band.png\" data-tags=\"\" height=\"254\" src=\"https://image.prepladder.com/content/bsD08AjTBcuUqXJrzj591739960077.png\" width=\"327\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Purely restrictive <span class=\"customMeta\" data-dictid=\"a9d3b38ddb16927771824feedb7ff9\">bariatric</span> procedure. Reduces hunger, likely through <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> mediation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Initial Placement: </strong>Marks the start of treatment, requiring ongoing management.</li>\n<li><strong>Band Adjustments: </strong>Involves specialist consultations to assess eating habits and then perform adjustments with <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> or <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> of <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> to achieve <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> control.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Challenges</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires frequent adjustments, associated with patient frustration and lower compliance, impacting long-term weight loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follow up</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monthly visits are recommended for the first year, with full multidisciplinary team (MDT) support.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early:</p>\n<ul>\n<li>Access port infection (1%)</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis(DVT)/ <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE)(&lt;0.1%)</li>\n</ul>\n<p>Late:</p>\n<ul>\n<li>Band infection</li>\n<li>Tubing leak</li>\n<li>Slippage</li>\n<li>Erosion into stomach</li>\n<li>Band intolerance</li>\n<li>Failure to lose weight/weight regain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally invasive, temporary procedure with an endoscopically placed balloon filled with <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> or air into the stomach.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Balloon serves as a restrictive mechanism and promotes the feeling of satiation as it is a space-occupying device.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Volume of balloon needed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A 400 mL balloon or larger can effectively induce satiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effectiveness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can achieve 6-15% total body weight loss compared to lifestyle <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> alone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FDA-Approved Balloons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obalon,</li>\n<li>Orbera,</li>\n<li>ReShape.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common adverse effects: Pain, nausea, GERD, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> ulcers, balloon migration</p>\n<p>Serious adverse effects: Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, perforation, death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Compliance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essential for success;</p>\n<p>Requires <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> to lifestyle modifications.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Nwn86eUWr7OSWHHlt2w21749105567.mp3", "video": ""}, {"text": "A 38-year-old woman with a BMI of 40 kg/m² undergoes sleeve gastrectomy. Post-surgery, she asks how the procedure helps her lose weight. What is the primary mechanism by which sleeve gastrectomy leads to weight loss?", "options": [{"label": "A", "text": "Reduced stomach size and hormonal changes.", "correct": true}, {"label": "B", "text": "Complete removal of the stomach.", "correct": false}, {"label": "C", "text": "Reduced appetite with no hormonal impact.", "correct": false}, {"label": "D", "text": "Nutrient malabsorption due to intestinal bypass.", "correct": false}], "correct_answer": "A. Reduced stomach size and hormonal changes.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YIvv6djmkgUZ65ZGkkwM1739959975.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sleeve gastrectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A recent, safe and effective <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> technique and a leading method in <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> surgery for treating <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> with higher survival rates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of a large part of the stomach, which regulates appetite.</li>\n<li>Does not require <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> or intestinal bypass.</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> and less technically challenging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Manu5 \" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Sleeve_gastrectomy#/media/File:Sleeve_Gastrectomy_Surgery.jpg\" data-tags=\"\" height=\"905\" src=\"https://image.prepladder.com/content/YIvv6djmkgUZ65ZGkkwM1739959975.png\" width=\"1252\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of weight loss (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss is achieved through both mechanical restriction (reduction of stomach size) and hormonal <span class=\"customMeta\" data-dictid=\"6c0c4e41b31692777192be0fbfce62\">modulation</span> (affecting hunger hormones such as ghrelin).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Weight Loss</li>\n<li>Reduce mental health problems</li>\n<li>Clinical Markers: Improve <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> profile, biochemical, histological, hematological and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> markers.</li>\n<li>Obesity-related disease resolution: Better control of <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> diabetes, non-alcoholic <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> liver disease, <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risk, obstructive sleep <span class=\"customMeta\" data-dictid=\"22b9ee5b2b16927771814b5d8d34ac\">apnea</span> and stroke risk.</li>\n<li>Non-obesity related disease remission: <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> attacks, <span class=\"customMeta\" data-dictid=\"09b955b4f91692777193bd4080e7fc\">musculoskeletal</span> pain, improved <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> pregnancy complications and lower cancer incidence.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early</p>\n<ul>\n<li>Leak at angle of His (1-2%)</li>\n<li>Intra-abdominal bleed (2-3%)</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis(DVT)/ <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE)(&lt;1%)</li>\n</ul>\n<p>Late</p>\n<ul>\n<li>Nutritional: Iron, vitamin B12, calcium,vitamin D deficiency</li>\n<li>Gastro-oesophageal reflux</li>\n<li>Barrett's esophagus</li>\n<li>Weight regain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0cvNkMbvQtTi6LvVgLIC1747155110.mp3", "video": ""}, {"text": "A 52-year-old woman is recovering from a recent Roux-en-Y gastric bypass surgery. She has been informed about the possible complications that can arise post-surgery. Which of the following is least likely to be a complication of her bypass surgery?", "options": [{"label": "A", "text": "Anastomotic leak", "correct": false}, {"label": "B", "text": "Internal hernia", "correct": false}, {"label": "C", "text": "Pancreatitis", "correct": true}, {"label": "D", "text": "Deep vein thrombosis", "correct": false}], "correct_answer": "C. Pancreatitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ktypYsuIp33YfRMjwDRE1739959861.png", "https://image.prepladder.com/content/AlWIWChMO0Eoy3jX8PQE1739959896.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mini-Gastric Bypass</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Roux-en-Y <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> Bypass</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves a longer <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> and then the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end of the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is connected to <span class=\"customMeta\" data-dictid=\"4b145c8d1b1692777190177246177d\">jejunum</span> about 150-250 cm from the <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of Treitz.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves the creation of a small <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> from the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> end of the stomach, which is then connected with the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> jejunum. Roux limb is varied between 100-150 cm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight loss</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss is by both restrictive and malabsorptive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Reto Krapf\" data-hash=\"\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Mini-bypass-gastrique-one-anastomosis-gastric-bypass-OAGP-C-Alila07_fig3_332623005\" data-tags=\"\" height=\"670\" src=\"https://image.prepladder.com/content/ktypYsuIp33YfRMjwDRE1739959861.png\" width=\"1044\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Arik Dahan Daniel Porat Milica Markovic[...] Peter Langguth\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Illustration-of-Roux-en-Y-gastric-bypass-RYGB_fig1_355992908\" data-tags=\"\" height=\"767\" src=\"https://image.prepladder.com/content/AlWIWChMO0Eoy3jX8PQE1739959896.png\" width=\"1051\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No. of Anastomosis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One:</p>\n<ul>\n<li>Gastro-jejunal anastomosis</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two:</p>\n<ul>\n<li>Gastro-jejunal anastomosis</li>\n<li>Jejunal-jejunal anastomosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early:</strong></p>\n<ol>\n<li>Anastomotic leak (&lt;1 %)<strong> (Option A)</strong></li>\n<li>Intra-abdominal bleed (2-3%)</li>\n<li>Unspecified <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (1-2%)</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis(DVT)/ <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE) (&lt;1%) <strong> (Option D)</strong></li>\n</ol>\n<p><strong>Late: </strong></p>\n<ol>\n<li>Internal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> <strong> (Option B)</strong></li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Malnutrition if long limb bypass; Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia; Vitamin B12 deficiency; <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> deficiency</li>\n<li>Anastomotic ulcer/ stricture</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZdQuoWV3rH9YkyhCv8v81749105353.mp3", "video": ""}, {"text": "A 40-year-old obese male visits the surgical OPD. He is advised to undergo a biliopancreatic diversion and duodenal switch (BPD-DS) surgery. What would not be a possible indication for BPD-DS?", "options": [{"label": "A", "text": "Higher BMIs", "correct": false}, {"label": "B", "text": "Failed another operation for weight loss", "correct": false}, {"label": "C", "text": "Failed surgery for metabolic control", "correct": false}, {"label": "D", "text": "Preexisting iron deficiency", "correct": true}], "correct_answer": "D. Preexisting iron deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/z9jIOPYm8VL5WocOpHw61739959665.png", "https://image.prepladder.com/content/0bTVNz0aiclxcHSRNkw41739959709.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Restrictive procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Malabsorptive procedures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduce the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> volume</li>\n<li>Triggers <span class=\"customMeta\" data-dictid=\"49fc1c346816927771930a677e41db\">neurohumoral</span> response of <span class=\"customMeta\" data-dictid=\"2e2efa1007169277719844bd43f5aa\">satiety</span> with smaller food portions</li>\n<li>Banding procedures</li>\n<li>Vertical banded gastroplasty</li>\n<li>Sleeve gastrectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reroute the track of normal absorption</li>\n<li>Removes a significant length of the gut, reducing nutrient absorption</li>\n<li>Jejuno-ileal bypass(JIB)</li>\n<li>Biliary-pancreatic <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> (BPD)</li>\n<li>BPD with <span class=\"customMeta\" data-dictid=\"19f521dfce16927771867e0a8713c9\">duodenal switch</span> (BPD-DS)</li>\n<li>Roux-en-Y <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> (RYGB)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vmHI4is8DPaeP5EgEp0E1749104661.mp3", "video": ""}, {"text": "In the preoperative assessment for obesity surgery, which of the following factors does NOT contribute to the obesity surgery mortality risk score?", "options": [{"label": "A", "text": "BMI &amp;gt;50 kg/m²", "correct": false}, {"label": "B", "text": "Female gender", "correct": true}, {"label": "C", "text": "Age &amp;gt;45 years", "correct": false}, {"label": "D", "text": "Hypertension", "correct": false}], "correct_answer": "B. Female gender", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:365px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk factor</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Points </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BMI &gt;50 kg/m<sup>2</sup></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Male gender</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age &gt;45 years</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk factors for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> thromboembolism</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Postoperative mortality</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.2</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jcSt7ec8CZGbdX2UWaNo1749104468.mp3", "video": ""}, {"text": "A patient is evaluated for obesity in the hospital for bariatric surgery. Which of the following would not be an indication for the surgery?", "options": [{"label": "A", "text": "BMI ≥ 40kg/m2 with no comorbidities", "correct": false}, {"label": "B", "text": "BMI ≥ 35kg/m2 with no comorbidities", "correct": true}, {"label": "C", "text": "Failure of previous nonsurgical attempts", "correct": false}, {"label": "D", "text": "BMI ≥ 37.5kg/m2 in Asian population with/without comorbidities", "correct": false}], "correct_answer": "B. BMI ≥ 35kg/m2 with no comorbidities", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>International Population </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Asian Population</strong></p>\n<p style=\"text-align: center;\"><strong>(metabolic surgery)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BMI ≥ 40kg/m2 with/without comorbidities<strong> (Option A)</strong></li>\n<li>BMI ≥ 35kg/m2 with comorbidities <strong> (Option B)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BMI ≥ 37.5kg/m2 with/without comorbidities <strong>(Option D)</strong></li>\n<li>BMI ≥ 32.5kg/m2 with comorbidities</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zyHCIq8yCnsVIDRrclJu1749104223.mp3", "video": ""}, {"text": "In which of the following situations is robotic surgery not suitable?", "options": [{"label": "A", "text": "Limited space/visualization", "correct": false}, {"label": "B", "text": "Surgeon suffers from tremors in hands", "correct": false}, {"label": "C", "text": "Gynecological operations", "correct": false}, {"label": "D", "text": "Low-budget surgical setup", "correct": true}], "correct_answer": "D. Low-budget surgical setup", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/In83DWcNoRREKGbWOD751739959550.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/meipNMsHxHerNeJ7qFRn1749104014.mp3", "video": ""}, {"text": "Which of the following statements about per-oral endoscopic myotomy is false?", "options": [{"label": "A", "text": "It is a modification of NOTES surgery", "correct": false}, {"label": "B", "text": "A flexible endoscope is used to create a submucosal tunnel", "correct": false}, {"label": "C", "text": "It is a good surgical technique for achalasia cardia", "correct": false}, {"label": "D", "text": "The procedure involves the division of longitudinal muscles", "correct": true}], "correct_answer": "D. The procedure involves the division of longitudinal muscles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pMQVGMdhLbsF9uWhVjIc1739959493.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cxX1Cq39dL7zoiuRJKta1749052340.mp3", "video": ""}, {"text": "A 20-year-old female comes to the OPD for an elective abdominal surgery. She is worried about developing a scar and enquires about a scarless procedure. Which among the following surgical procedures gives a scarless result?", "options": [{"label": "A", "text": "Laparoscopic abdominal surgery", "correct": false}, {"label": "B", "text": "Laparotomy", "correct": false}, {"label": "C", "text": "Natural orifice transluminal endoscopic surgery", "correct": true}, {"label": "D", "text": "Hand-assisted laparoscopic surgery", "correct": false}], "correct_answer": "C. Natural orifice transluminal endoscopic surgery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ep956SrCuiXpiFFPEOKK1739959449.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WELESpIRbzGqhtMzhrkn1749052234.mp3", "video": ""}, {"text": "A 25-year-old female who underwent a simple mastectomy was admitted in the hospital and discharged on the same day after the procedure. What type of surgery is this?", "options": [{"label": "A", "text": "Day surgery", "correct": true}, {"label": "B", "text": "Fast track surgery", "correct": false}, {"label": "C", "text": "Overnight stay surgery", "correct": false}, {"label": "D", "text": "Short stay surgery", "correct": false}], "correct_answer": "A. Day surgery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oqsTxilKUCcm7UU3TlBH1749052134.mp3", "video": ""}, {"text": "A laparoscopic surgery was done on a patient for cholecystitis, and he later complained of shoulder pain. What would be the most possible cause for this?", "options": [{"label": "A", "text": "Intrabdominal abscess", "correct": false}, {"label": "B", "text": "Mesenteric bleeding", "correct": false}, {"label": "C", "text": "Perforation of esophagus", "correct": false}, {"label": "D", "text": "Splenic trauma", "correct": true}], "correct_answer": "D. Splenic trauma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PfXTVA393i4dXwRE74Mx1749052034.mp3", "video": ""}, {"text": "A 45-year-old patient is about to undergo a cholecystectomy. He has no other comorbidities and wants a minimally invasive surgery; hence, the surgeon suggests a laparoscopic cholecystectomy. Which of the following gases is most widely used for creating a pneumoperitoneum?", "options": [{"label": "A", "text": "Room air", "correct": false}, {"label": "B", "text": "O2 (oxygen)", "correct": false}, {"label": "C", "text": "CO2 (carbon dioxide)", "correct": true}, {"label": "D", "text": "He (helium)", "correct": false}], "correct_answer": "C. CO2 (carbon dioxide)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wVjhw3iGYK0QQvv0ywjD1749051813.mp3", "video": ""}, {"text": "A diabetic patient with severe sepsis develops a persistent urinary tract infection (UTI) despite antibiotic treatment. The infection control team suspects a multidrug-resistant pathogen. Which of the following is true about nosocomial infections?", "options": [{"label": "A", "text": "Staphylococcus aureus is the most common cause of hospital-acquired respiratory infections.", "correct": false}, {"label": "B", "text": "Klebsiella is a frequent cause of drug-resistant hospital-acquired UTIs.", "correct": true}, {"label": "C", "text": "Nosocomial infections are not typically transmitted between patients.", "correct": false}, {"label": "D", "text": "Patients with artificial prostheses are less prone to nosocomial infections than those with indwelling devices.", "correct": false}], "correct_answer": "B. Klebsiella is a frequent cause of drug-resistant hospital-acquired UTIs.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hospital <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">Acquired</span> Infections:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acquired infections after 48 hours of hospital admission that were neither present <span class=\"customMeta\" data-dictid=\"fe5171bb0016927771933a5ca5d376\">nor</span> incubating at the time of admission.</li>\n<li>Spread by healthcare workers or between patients if <span class=\"customMeta\" data-dictid=\"50ca3536ab16927771820138ef02f8\">aseptic</span> measures are not followed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Risk Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diabetics</li>\n<li>Immunosuppressed individuals</li>\n<li>Patients on steroids, life-supporting machines.</li>\n<li>Instrumentation (indwelling catheter, IV cannula, <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">tracheostomy</span> tube)</li>\n<li>Patients with artificial prostheses</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Pathogens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Wound infection: </strong>Staphylococcus aureus (most common), Pseudomonas, Klebsiella, E.coli, Proteus.</li>\n<li><strong>Respiratory <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections: </strong>Streptococcus pneumoniae, Haemophilus, Herpes, Varicella, Aspergillus, <span class=\"customMeta\" data-dictid=\"af71e1cffa16927771950a5fb2c281\">Pneumocystis</span> carinii.</li>\n<li><strong>UTIs:</strong> <span class=\"customMeta\" data-dictid=\"50f3c6e8dd16927771902c55d555b8\">Klebsiella</span> (most common).</li>\n<li><strong>Antibiotic-associated diarrhea: </strong>Clostridium difficile.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most organisms invading are multidrug-resistant and <span class=\"customMeta\" data-dictid=\"417d56229b1692777202ce72999b28\">virulent</span> and hence cause severe sepsis.</p>\n<ul>\n<li>Antibiotics based on culture results.</li>\n<li>Blood, urine, <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> for culture and sensitivity to isolate the organisms.</li>\n<li>Supportive care (e.g., ventilator, nutrition, maintaining <span class=\"customMeta\" data-dictid=\"9627da6bc21692777194438ac75f8d\">optimum</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Isolate infected patients.</li>\n<li>Follow strict <span class=\"customMeta\" data-dictid=\"50ca3536ab16927771820138ef02f8\">aseptic</span> practices.</li>\n<li>Disinfect facilities, treat underlying conditions and proper nutrition.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1e1bvqzfoS2PQCuMCBjV1749050805.mp3", "video": ""}, {"text": "A 55-year-old woman, 4 days post-abdominal surgery, reports a sudden feeling of popping at her surgical site followed by the drainage of pinkish fluid. On examination, there is partial wound dehiscence with no visible bowel protrusion. What is the next best step in management?", "options": [{"label": "A", "text": "Prompt reclosure of the fascia", "correct": true}, {"label": "B", "text": "Apply a wound vacuum system and monitor", "correct": false}, {"label": "C", "text": "Prescribe oral antibiotics and discharge", "correct": false}, {"label": "D", "text": "Place an abdominal binder and observe", "correct": false}], "correct_answer": "A. Prompt reclosure of the fascia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gTQeflCSmfKiQTC0IRFb1739959262.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wound Dehiscence</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disruption of any or all of the layers in a wound.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occurrence </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 3% of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds; most commonly occurs between the 5th and 8th <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Partial dehiscence:</strong> Involves only the skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat.</li>\n<li><strong>Complete dehiscence: </strong>Involves the fascial layer and may include <span class=\"customMeta\" data-dictid=\"00fc1a6b38169277718780d2bc69d1\">evisceration</span> (extrusion of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscera).</li>\n</ol>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4120\" src=\"https://image.prepladder.com/content/gTQeflCSmfKiQTC0IRFb1739959262.png\" width=\"3850\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General:</strong></p>\n<ul>\n<li>Malnourishment</li>\n<li>Diabetes</li>\n<li>Obesity</li>\n<li>Renal failure</li>\n<li>Jaundice</li>\n<li>Sepsis</li>\n<li>Cancer</li>\n<li>Treatment with steroids</li>\n<li>Emergency surgery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local:</strong></p>\n<ul>\n<li>Inadequate or poor <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of wound or <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of a wound under tension</li>\n<li>Poor local wound healing</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> pressure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pinkish serosanguinous <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (salmon-coloured fluid),</li>\n<li>Possible evisceration,</li>\n<li>Popping sensation during straining or coughing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Partial <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> (without evisceration): </strong>Prompt reclosure of the <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> is generally advised. <strong>(Option A)</strong></li>\n<li><strong>Complete <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> with evisceration:</strong></li>\n</ul>\n<ul>\n<li>Requires urgent reoperation.</li>\n<li>Tension suturing is done.</li>\n<li>Protect eviscerated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> with moist towels; handle carefully to prevent injury.</li>\n<li>Antibiotic therapy; fluid management.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/n7LolhWBA9Gvvlv38zxO1749051501.mp3", "video": ""}, {"text": "A 68-year-old man develops a fever of 101.5°F on postoperative day 5 after total hip replacement. He also has localized pain and swelling in his left calf. The chest X-ray is normal, and there are no respiratory symptoms. What is the most likely cause of his fever?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Thrombophlebitis", "correct": true}, {"label": "C", "text": "Deep infections", "correct": false}, {"label": "D", "text": "Gas gangrene of wound", "correct": false}], "correct_answer": "B. Thrombophlebitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:565px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">Postoperative</span> Fever</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate Fever: </strong>Fever occurs immediately after surgery or within hours on <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> days (POD) 0 or 1.</p>\n<ul>\n<li>Malignant Hyperthermia</li>\n<li>Bacteremia</li>\n<li>Gas <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> of the wound <strong>(Option D)</strong></li>\n<li>Febrile non-hemolytic <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reaction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Fever: </strong>Fever occurs in the first week (POD 1 to 7).</p>\n<ul>\n<li>POD 1: <span class=\"customMeta\" data-dictid=\"4b8917adbd1692777196c4f3c7dc8f\">Pyretic</span> response to surgery</li>\n<li>POD 3: Unresolved <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> resulting in pneumonia; development of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection (UTI)</li>\n<li>POD 5: <span class=\"customMeta\" data-dictid=\"31f2c60d1e1692777200a4eae70af9\">Thrombophlebitis</span> <strong>(Option B)</strong></li>\n<li>POD 7: <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> <strong>(Option A)</strong></li>\n<li>POD 7 (5 to 10): Wound infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subacute Fever: </strong>Fever occurs between <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> weeks 1 and 4.</p>\n<ul>\n<li>POD 10: Deep infections <strong>(Option C)</strong></li>\n<li>Drugs reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed Fever:</strong> Fever after &gt;4 weeks.</p>\n<ul>\n<li>Skin and soft tissue infection (SSTI)</li>\n<li>Viral infections</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jejYE2X7HOJqjaAfnhEH1749051350.mp3", "video": ""}, {"text": "In the operating room, the surgical team is completing the WHO Surgical Safety Checklist. They are focused on final checks before closing the incision. Which of the following is not a standard checklist item at this stage?", "options": [{"label": "A", "text": "Confirm patient identity.", "correct": false}, {"label": "B", "text": "Verify surgical team roles.", "correct": false}, {"label": "C", "text": "Reviewing anesthesia concerns.", "correct": false}, {"label": "D", "text": "Checking the patient's COVID-19 status.", "correct": true}], "correct_answer": "D. Checking the patient's COVID-19 status.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZQHMC6u0AL3QgdoooaUW1739959187.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fwl1bBJo7nHi5nTUhFJM1749051214.mp3", "video": ""}, {"text": "A 50-year-old man develops sudden respiratory distress, altered consciousness and hypotension during a craniotomy surgery. The anesthesiologist hears a mill-wheel murmur and suspects an air embolism. What is the most appropriate immediate action?", "options": [{"label": "A", "text": "Administer a diuretic.", "correct": false}, {"label": "B", "text": "Perform CPR.", "correct": false}, {"label": "C", "text": "Place in Trendelenburg position.", "correct": true}, {"label": "D", "text": "Administer epinephrine.", "correct": false}], "correct_answer": "C. Place in Trendelenburg position.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:577px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air Embolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs when air enters accidentally into the <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> system.Commonly <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> via interventional procedures, but also from trauma, diving, childbirth, and other circumstances.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Through <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> access like IV cannula.</li>\n<li>Artificial Pneumothorax.</li>\n<li>Surgeries of neck and axilla.</li>\n<li>Traumatic opening of major veins sucking air inside.</li>\n<li>Fallopian tube insufflation.</li>\n<li>Laparoscopic surgeries.</li>\n<li>Illegal abortions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Respiratory Distress,</li>\n<li>Hemoptysis,</li>\n<li>Convulsions,</li>\n<li>Unconsciousness,</li>\n<li>Visual and hearing disturbances,</li>\n<li>Fatigue and numbness,</li>\n<li>Paralysis,</li>\n<li>Hemodynamic instability,</li>\n<li>Coma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patient history especially relation to recent procedures.</li>\n<li><strong>Auscultation: </strong>Millwheel <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> heard over the <span class=\"customMeta\" data-dictid=\"c8c31756a91692777196ce89e90359\">precordium</span> is diagnostic.</li>\n<li><strong>ECG: </strong>ST depression and <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> strain due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> obstruction.</li>\n<li><strong>Capnometry: </strong>Decreased <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels in intubated patients.</li>\n<li><strong>Imaging: </strong>Chest X-ray, <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> ultrasonography, <span class=\"customMeta\" data-dictid=\"8ba00f15d31692777200f1c6d2cbae\">transesophageal</span> <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> (TEE).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Positioning:</strong></li>\n</ul>\n<ol>\n<li><strong>Trendelenburg position: </strong>Keeps air bubbles away from <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arteries.<strong>(Option C)</strong></li>\n<li><strong>Left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"f518295be51692777185698bd9b0fd\">decubitus</span> position: </strong>Helps trap air in the non-dependent segment of the right ventricle, preventing it from entering the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery.</li>\n</ol>\n<ul>\n<li><strong>Hyperbaric oxygen therapy: </strong>Useful in both <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> and arterial <span class=\"customMeta\" data-dictid=\"be979fef2116927771810a6beec32c\">air embolism</span> as it reduces ischemia, bubble size; in arterial <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> it removes <span class=\"customMeta\" data-dictid=\"391d32291016927771932bab695579\">nitrogen</span> from bubbles to improve <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> and oxygenation.</li>\n<li><strong>Aspiration: </strong>Air should be aspirated from the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> with a needle.</li>\n<li><strong>Open Thoracotomy: </strong>Life-saving procedure required to <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> air causing the block.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dmk3XAnhDc6xiHx1G1dy1749051107.mp3", "video": ""}, {"text": "A 55-year-old female patient is scheduled for lateral thoracotomy. The surgical team prepares to position her on the operating table. Which position should the patient be placed in for optimal access to the thorax?", "options": [{"label": "A", "text": "Jackknife Position", "correct": false}, {"label": "B", "text": "Lateral Decubitus Position", "correct": true}, {"label": "C", "text": "Lithotomy Position", "correct": false}, {"label": "D", "text": "Trendelenburg Position", "correct": false}], "correct_answer": "B. Lateral Decubitus Position", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3lBciOEwDI40VQonkJNP1739958802.png", "https://image.prepladder.com/content/uAX2hWvDC0iG39n1uUjf1739958841.png", "https://image.prepladder.com/content/Mxp6HSjoLy6nLSPSiUot1739958887.png", "https://image.prepladder.com/content/tG57ykLHZkvyHkbE0aY21739958918.png", "https://image.prepladder.com/content/3wP6fQbVyVj4sFnwYPLo1739958959.png", "https://image.prepladder.com/content/qubApMP104ZYf1xgih3R1739959002.png", "https://image.prepladder.com/content/QCVn4d7cYQ5wIzGDdgsd1739959035.png", "https://image.prepladder.com/content/TJyDbYRGJQ5jzNeKtO6r1739959063.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Uses and Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Supine Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Most common position for general <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures.</p>\n<p><u>Modifications of <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">Supine</span> position:</u></p>\n<ul>\n<li>Rose’s position</li>\n<li>Shoulder and Arm Extended</li>\n<li>Trendelenburg Position</li>\n<li>Reverse Trendelenburg Position</li>\n<li>Fowler's Position</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>General surgeries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rose's Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Supine with slight neck extension.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Head and neck surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Shoulder and Arm Extended</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Supine with shoulder and arm extended.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Axillary and breast surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Trendelenburg Position</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Head end tilted down, knees slightly flexed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pelvic procedures, resuscitating patients in shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reverse Trendelenburg Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Head end tilted upward, placing the head higher than the feet.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries.</p>\n\t\t\t \n\n\t\t\t<p><strong>Complication: </strong>Right shoulder pain due to CO2 collected under the right <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> during <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fowler's Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Semi-sitting with trunk raised at 40° and knees bent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neurosurgery, shoulder surgeries, patients with heart or <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure.</p>\n\t\t\t \n\n\t\t\t<p><strong>Complication: </strong>Increased risk of air embolism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prone Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Patient is intubated and log-rolled onto the operating bed with help.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spinal surgery, extra <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> abdominoperineal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for rectal cancer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jackknife Position</strong></p>\n<p><strong>(Option A)</strong></p>\n<p>(Prone Position Modification)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chest supported, <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> relaxed by flexing at the hips.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Provides excellent access to the perineum.</p>\n\t\t\t \n\n\t\t\t<p><strong>Complication: </strong>Positional asphyxia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"f518295be51692777185698bd9b0fd\">Decubitus</span> or <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Position </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower leg flexed, pillow between legs, upper leg flexed in an exaggerated position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Draining abscesses, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> thoracotomy, urological and <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> procedures.</p>\n\t\t\t \n\n\t\t\t<p><strong>Complication:</strong> Increased risk of <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> injury due to hyperextension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lithotomy Position</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Supine with hips and knees flexed, legs in stirrups, hips flexed to 90°.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gynecological, perineal, and urological procedures.</p>\n\t\t\t \n\n\t\t\t<p><strong>Complication: </strong>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve injury if legs are not supported properly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lloyd-Davies Position</strong> (Lithotomy Modification)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Supine with hips minimally flexed (~15°) and a 30° head-down tilt.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gynecological, perineal, and urological procedures.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ly1asIEAOfkIb6zxm7Os1749050976.mp3", "video": ""}, {"text": "A patient’s wound, evaluated on postoperative day 7, shows signs of erythema, pain and swelling with no discharge and deep tissue involvement. What is the likely Southampton wound grading?", "options": [{"label": "A", "text": "Grade I", "correct": false}, {"label": "B", "text": "Grade II", "correct": true}, {"label": "C", "text": "Grade III", "correct": false}, {"label": "D", "text": "Grade IV", "correct": false}], "correct_answer": "B. Grade II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Grade</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Appearance</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Subtypes</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>0</p>\n</td>\n<td colspan=\"2\">\n<p>Normal healing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>I <strong>(Option A)</strong></p>\n</td>\n<td>\n<p>Normal <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> with mild bruising or erythema</p>\n</td>\n<td>\n<p>A: Some bruising</p>\n<p>B: Considerable bruising</p>\n<p>C: Mild erythema</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>II <strong>(Option B)</strong></p>\n</td>\n<td>\n<p>Erythema plus other signs of inflammation</p>\n</td>\n<td>\n<p>A: At 1 point</p>\n<p>B: Around sutures</p>\n<p>C: Along wound</p>\n<p>D: Around wound</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>III <strong>(Option C)</strong></p>\n</td>\n<td>\n<p>Clear or haemoserous discharge</p>\n</td>\n<td>\n<p>A: At 1 point only (&lt;2 cm)</p>\n<p>B: Along wound (&gt;2 cm)</p>\n<p>C: Large volume</p>\n<p>D: Prolonged (&gt;3 days)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>IV <strong>(Option D)</strong></p>\n</td>\n<td>\n<p>Pus</p>\n</td>\n<td>\n<p>A: At 1 point only (&lt;2 cm)</p>\n<p>B: Along wound (&gt;2 cm)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>V</p>\n</td>\n<td colspan=\"2\">\n<p>Deep or severe infection with or without tissue breakdown; haematoma requiring aspiration</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Parameters</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>A</strong>dditional treatment:</p>\n<ol>\n<li>Antibiotics</li>\n<li>Pus drainage</li>\n<li>Wound debridement</li>\n</ol>\n</td>\n<td> \n\t\t\t<p>10</p>\n<p>5</p>\n<p>10</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>S</strong>erous <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> - For 5 days of first 7 days of wound infection</p>\n</td>\n<td>\n<p>0-5 Daily</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E</strong>rythema - For 5 days of first 7 days of wound infection</p>\n</td>\n<td>\n<p>0-5 Daily</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>P</strong>urulent fluid - For 5 days of first 7 days of wound infection</p>\n</td>\n<td>\n<p>0-10 Daily</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>S</strong>eparation of deep tissues - For 5 days of first 7 days of wound infection</p>\n</td>\n<td>\n<p>0-10 Daily</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>I</strong>solation of bacteria</p>\n</td>\n<td>\n<p>10</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>S</strong>tay in the hospital (in-patient) &gt;14 days due to infection</p>\n</td>\n<td>\n<p>5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QVvAVl0CkPEa7evun8Tm1749106038.mp3", "video": ""}, {"text": "Which of the following correctly matches the zone in an OT (Operating Theatre) complex with its primary function?", "options": [{"label": "A", "text": "Protective zone: Includes the sterile operation rooms.", "correct": false}, {"label": "B", "text": "Clean zone: Primarily contains the change rooms for medical and paramedical staff.", "correct": false}, {"label": "C", "text": "Aseptic zone: Contains the sterile operating rooms.", "correct": true}, {"label": "D", "text": "Disposal zone: Connected directly to the aseptic zone and contains the patient transfer bay.", "correct": false}], "correct_answer": "C. Aseptic zone: Contains the sterile operating rooms.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZSVIlaxE8NfA8z9uv4431749109254.mp3", "video": ""}, {"text": "Which of the following strategies is most effective in preventing surgical site infections (SSIs) during an operation?", "options": [{"label": "A", "text": "Administering prophylactic antibiotics before the first incision and maintaining positive pressure in the operating room (OR).", "correct": true}, {"label": "B", "text": "Using concentric circles for antisepsis application and maintaining the OR temperature at 18 ± 3°C.", "correct": false}, {"label": "C", "text": "Administering antibiotics after the operation and maintaining a negative pressure differential in the OR.", "correct": false}, {"label": "D", "text": "Avoiding alcohol-based antiseptic solutions and using antibiotics with a short tissue half-life.", "correct": false}], "correct_answer": "A. Administering prophylactic antibiotics before the first incision and maintaining positive pressure in the operating room (OR).", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prophylactic Considerations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prophylactic Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administered before the first <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> to ensure <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> levels are present in tissues at the time of incision, reducing the risk of bacterial contamination. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operating Room (OR) Air Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive pressure <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">differential</span> in the OR is essential to keep outside air from entering, preventing <span class=\"customMeta\" data-dictid=\"5a986778421692777180f5f9dd3ea8\">airborne</span> <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> and reducing the risk of <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Site Infections (SSIs). <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antisepsis Application Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concentric circles are often used, but WHO guidelines state that the specific pattern (concentric circles, <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> or vertical) does not significantly impact SSI prevention. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operating Room Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recommended OR temperature is 21 ± 3°C. A temperature of 18°C is too low, potentially causing <span class=\"customMeta\" data-dictid=\"9723be730516927771896878ec012a\">hypothermia</span> in patients, negatively affecting wound <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> and outcomes. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin <span class=\"customMeta\" data-dictid=\"b0cf6892ae169277718116c4a1e6d6\">Antisepsis</span> Solution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alcohol-based solutions like <span class=\"customMeta\" data-dictid=\"9e3074aff11692777184825ada3019\">chlorhexidine</span> alcohol are recommended for skin <span class=\"customMeta\" data-dictid=\"b0cf6892ae169277718116c4a1e6d6\">antisepsis</span> because of their effectiveness in reducing <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> organisms and preventing SSIs. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic Selection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibiotics with a short <span class=\"customMeta\" data-dictid=\"082d1526db1692777188311b6eef04\">half-life</span> might not maintain adequate tissue levels throughout surgery. Long-acting antibiotics or those that can be re-dosed during long surgeries are preferred. <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/69iL2lOSlKBUXG5Z1RAx1749107164.mp3", "video": ""}, {"text": "A 62-year-old man with hypovolemic shock requires rapid fluid resuscitation. Which of the following IV catheters would be most appropriate for this situation?", "options": [{"label": "A", "text": "22G yellow catheter", "correct": false}, {"label": "B", "text": "18G green catheter", "correct": false}, {"label": "C", "text": "14G orange catheter", "correct": true}, {"label": "D", "text": "24G blue catheter", "correct": false}], "correct_answer": "C. 14G orange catheter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9dG9vM0z11Usqf7ldDo51739958595.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gauge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Flow Rate (mL/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Typical Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>14</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orange</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>270</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid transfusion, trauma, Large volume replacement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gray</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>236</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large volume infusion, blood transfusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Green</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>103</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood products, contrast study, surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pink</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>67</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General IV access</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>22</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>42</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, fragile veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pediatric use</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oZNhbx2mw6vcYdlQQhN81749107015.mp3", "video": ""}, {"text": "A 28-year-old man from a resource-poor area presents with a 3-week history of fever, abdominal pain, and altered bowel habits. Abdominal examination reveals a doughy feel and a mass in the right iliac fossa. Which finding would most likely distinguish intestinal tuberculosis from typhoid fever in this patient?", "options": [{"label": "A", "text": "Evening rise in temperature", "correct": false}, {"label": "B", "text": "Positive blood culture for Salmonella Typhi", "correct": false}, {"label": "C", "text": "Multiple longitudinal ulcers in the terminal ileum", "correct": false}, {"label": "D", "text": "Caseating granulomas on intestinal biopsy", "correct": true}], "correct_answer": "D. Caseating granulomas on intestinal biopsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SskyYDp8SeGv80NTGY461739958537.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:708px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intestinal Tuberculosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Typhoid (Enteric Fever)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mycobacterium tuberculosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Salmonella typhi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mode of Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ingestion of food contaminated with <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> bacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fecal-oral route</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Appearance (Ulcer Description)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ulcers are transverse, often circumferential, forming a \"girdle\" shape.</li>\n<li>Typically multiple ulcers.</li>\n<li>Located mostly in the Ileocaecal region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ulcers are longitudinal, multiple and arranged in a <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> and <span class=\"customMeta\" data-dictid=\"387d6e04781692777181f08c20c77b\">antimesenteric</span> pattern.</li>\n<li>Often occur in the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> and Peyer's patches.</li>\n<li>Ulcers can perforate, leading to peritonitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of granulomas with caseating necrosis.</li>\n<li>Epithelioid cells and Langhans giant cells are common.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lymphoid <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> is noted.</li>\n<li>Neutropenia and <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> may also be observed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dull, colicky <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, often in the right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> fossa.</li>\n<li>Weight loss, fever, and <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> are common.</li>\n<li>Mass may be felt in the right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> (indicating ileocaecal involvement).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presents initially with fever, chills, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n<li>Severe diarrhea, relative bradycardia, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> are common.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intestinal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> due to<strong> <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> formation. </strong></li>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> and <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> formation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intestinal hemorrhage.</li>\n<li><strong>Perforation </strong>leading to faecal peritonitis.</li>\n<li>Paralytic <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> is a common complication.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histology: Granulomas, Langhans giant cells and caseating <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> are diagnostic.</li>\n<li>IFN-γ release assays</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Widal test, blood cultures positive for S. typhi.</li>\n<li>PCR <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> for <span class=\"customMeta\" data-dictid=\"f2f6f9068216927772016cacf26183\">typhoid</span> is also useful.</li>\n<li>X-ray may show gas under the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> if <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> is present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-tubercular therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibiotics (e.g., cephalosporins)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qmYb6ubwmOsQ3dpbMKmp1749106848.mp3", "video": ""}, {"text": "A 48-year-old male immigrant presents with a painless, fluctuating mass in the neck that has been gradually enlarging over 2 months, along with an evening rise in temperature and weight loss. On examination, there is a 3 cm soft, non-tender swelling in the left posterior triangle of the neck without signs of inflammation. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Incision and drainage", "correct": false}, {"label": "B", "text": "Fine needle aspiration cytology", "correct": false}, {"label": "C", "text": "Excisional biopsy", "correct": true}, {"label": "D", "text": "Empiric antitubercular therapy", "correct": false}], "correct_answer": "C. Excisional biopsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9SqT9mvvwMQKwytCUluu1739958483.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mycobacterium tuberculosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neck <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes (80%), especially upper deep <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> (jugulodigastric - 54%)</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes (22%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Firm, matted <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation</li>\n<li>Sinus formation with yellowish caseating discharge</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Firm, matted <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes with yellowish caseating material on cut section</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Epithelioid cells with caseating material</li>\n<li>Langhans giant cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Lymphadenitis:</strong> Discrete, firm/hard, mobile, non-tender nodes</p>\n<p>2. <strong>Matting:</strong> Nodes move together <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> masse due to periadenitis</p>\n<p>3. <strong>Cold Abscess:</strong> Deep to deep fascia</p>\n<p>4. <strong>Collar-stud Abscess:</strong> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> through the deep fascia, adherent to skin</p>\n<p>5. <strong>Sinus Formation:</strong> Discharges yellowish caseating material</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1058\" src=\"https://image.prepladder.com/content/9SqT9mvvwMQKwytCUluu1739958483.png\" width=\"969\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hyperplastic:</strong> 20% cases, discrete, firm, or hard nodes</li>\n<li><strong>Caseating:</strong> 75-80% cases, matted nodes, often with cold abscess</li>\n<li><strong>Atrophic:</strong> Rare, small <span class=\"customMeta\" data-dictid=\"ae1132b13e1692777182aec918eee0\">atrophied</span> nodes, caseating type</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>FNAC:</strong> Useful for detecting <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells and Langhans giant cells</li>\n<li><strong>Ultrasound neck:</strong> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> size, matting, cold abscess, and <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracking</li>\n<li><strong>Chest X-ray:</strong> To detect associated <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> tuberculosis</li>\n<li><strong>Mantoux test:</strong> May be useful but not very reliable</li>\n<li><strong>CT neck and chest:</strong> For nodal status</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antitubercular Drugs:</strong> Rifampicin, INH, Ethambutol, <span class=\"customMeta\" data-dictid=\"34a5f1798516927771964e58d7a988\">Pyrazinamide</span> (for 6-9 months)</li>\n<li><strong>Aspiration:</strong> Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> is aspirated to prevent <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> formation</li>\n<li><strong>Incision and Drainage:</strong> If <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> recurs</li>\n<li><strong>Surgical Removal:</strong> Indicated if there is no response to drugs or <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> persists</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LKypvhlbSu0UvYgRHuWc1749106701.mp3", "video": ""}, {"text": "A 56-year-old diabetic male presents with severe leg pain, swelling, dusky discoloration, and bullae, 24 hours after a minor cut. The leg is edematous with crepitus, and the patient is febrile and tachycardic, showing signs of septic shock. What is the most appropriate next step?", "options": [{"label": "A", "text": "Monitor and observe", "correct": false}, {"label": "B", "text": "Immediate surgical debridement", "correct": true}, {"label": "C", "text": "IV fluids and pain management", "correct": false}, {"label": "D", "text": "IV antibiotics", "correct": false}], "correct_answer": "B. Immediate surgical debridement", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lQKF657NFqNMaO5EwcHC1739958377.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Necrotizing fasciitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a severe, rapidly <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> infection that produces <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues and overlying skin associated with significant <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common: Group A β-haemolytic Streptococci.</li>\n<li>Occasionally <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus.</li>\n<li>Can be polymicrobial, involving Bacteroides, Clostridium, Proteus, <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> and Klebsiella.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fournier's gangrene: </strong>Affects the <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> area.</li>\n<li><strong>Meleney's gangrene: </strong>Involves the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> infiltrate.</li>\n<li>Extensive necrosis, edema, and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of microvasculature.</li>\n<li>Dusky blue and black skin, <span class=\"customMeta\" data-dictid=\"fc2efe08081692777183a5a07d6101\">bullae</span> and progress to <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> gangrene.</li>\n<li>Rapid spread with possible skip lesions, later coalesce.</li>\n<li>Accompanied by fever, severe toxicity, and potential <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure due to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predisposing Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diabetes mellitus,</li>\n<li>Smoking,</li>\n<li>Penetrating trauma,</li>\n<li>Pressure sores,</li>\n<li>Immunosuppression,</li>\n<li>Intravenous drug abuse,</li>\n<li>Perineal infections,</li>\n<li>Skin damage/infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs and Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Local:</li>\n<li>Unusual pain,</li>\n<li>Erythema, edema, warmth,</li>\n<li>Crepitus,</li>\n<li>Blisters, bullae,</li>\n<li>Grayish <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> (dishwasher pus),</li>\n<li>Fixed staining,</li>\n<li>Necrosis, gangrene.</li>\n<li>Systemic:</li>\n<li>Fever, tachycardia, tachypnea,</li>\n<li>Shock,</li>\n<li>Coagulopathy,</li>\n<li>Multiorgan failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Based on clinical presentation.</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> levels.</li>\n<li>Biopsy of fascial layers confirms diagnosis.</li>\n<li>Radiographs may show air in tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> admission with monitoring of volume status and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function.</li>\n<li>Administer oxygen; <span class=\"customMeta\" data-dictid=\"ec62425aa9169277719050edbb4d55\">intubate</span> if necessary.</li>\n<li>High-dose IV <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> G and <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics (e.g., third-generation cephalosporins, metronidazole).</li>\n<li>Immediate, aggressive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with daily <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> changes.</li>\n<li>Multiple debridements may be needed.</li>\n<li>Large wounds may require skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> or <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> coverage.</li>\n<li>Vacuum-assisted dressings and early skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> aid <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> and minimize fluid loss. <span class=\"customMeta\" data-dictid=\"1b1cc7f2861692777189c9bd7d9b81\">Hyperbaric</span> oxygen therapy can reduce mortality.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mortality </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between 30% and 50%, even with prompt <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> intervention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Piotr Smuszkiewicz, Iwona Trojanowska and Hanna Tomczak\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Necrotizing_fasciitis#/media/File:Necrotizing_fasciitis_left_leg.JPEG\" data-tags=\"\" height=\"1055\" src=\"https://image.prepladder.com/content/lQKF657NFqNMaO5EwcHC1739958377.png\" width=\"1789\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XYKGDPUW1O51FdcCSQ9K1749106550.mp3", "video": ""}, {"text": "A 45-year-old man presents with severe muscle pain and swelling in his leg following a gunshot wound. The wound has a foul-smelling, brown discharge and shows signs of crepitus. X-rays reveal gas in the soft tissues. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hidradenitis Suppurativa", "correct": false}, {"label": "B", "text": "Fournier’s Gangrene", "correct": false}, {"label": "C", "text": "Gas Gangrene", "correct": true}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "C. Gas Gangrene", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NGnBurOJ0hXt4v9qGJK91739958275.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gas Gangrene</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rapidly progressive, potentially fatal condition characterized by widespread <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of muscles and soft-tissue destruction, often due to late-presenting missile wounds or crushing injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clostridium perfringens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;24 hours but ranges from 1 hour to 6 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sources and <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Contaminated soil and feces.</li>\n<li>Wounds with necrotic or foreign material.</li>\n<li>Crush wounds, road traffic accidents, amputations.</li>\n<li>Anaerobic environments in the wound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adductor region of the <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> and buttocks.</li>\n<li>Subscapular region in the upper limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe pain with limb <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> rapidly increases in severity.</li>\n<li>Serosanguineous discharge.</li>\n<li>Skin turns brown to blue-black with hemorrhagic bullae.</li>\n<li>Sweet, sticky <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> &amp; Soft-tissue crepitus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Septicaemia, toxemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, liver failure.</li>\n<li>Circulatory failure, DIC, secondary infections.</li>\n<li>Death occurs in critically ill patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray: Gas in soft tissues.</li>\n<li>Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> &amp; blood culture: Large <span class=\"customMeta\" data-dictid=\"c72cd5f69316927771883c73649d86\">Gram-positive</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> without neutrophils.</li>\n<li>Biochemical profile: <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> acidosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Peripheral blood smear: Haemolysis.</li>\n<li>CT scan for chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> and clindamycin, along with 3rd generation cephalosporins, are given intravenously.</li>\n<li>Polyvalent antiserums given intravenously.</li>\n<li>All dead tissues are excised, and debridement is performed until healthy tissue bleeds.</li>\n<li>Amputation done in severe cases</li>\n<li>Hyperbaric oxygen therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Proper debridement of devitalized crushed wounds.</li>\n<li>Devitalized wounds should not be sutured.</li>\n<li>Adequate cleaning of wounds with H₂O₂ and normal saline.</li>\n<li>Penicillin - As a <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Engelbert Schröpfer, Stephan Rauthe and Thomas Meyer\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Gas_gangrene#/media/File:Gas_gangrene.jpg\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/NGnBurOJ0hXt4v9qGJK91739958275.png\" width=\"1229\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wVh2d1mtjdzM7UHrofC31749106436.mp3", "video": ""}, {"text": "A 55-year-old diabetic male presents with a 2-day history of increasing redness, warmth, and swelling in his left leg and also has fever and chills. The erythema is rapidly expanding, with no clear demarcation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Carbuncle", "correct": false}, {"label": "B", "text": "Cellulitis", "correct": true}, {"label": "C", "text": "Erysipelas", "correct": false}, {"label": "D", "text": "Necrotizing fasciitis", "correct": false}], "correct_answer": "B. Cellulitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Bic2ldQqXbXeYBxhbkyK1739958048.png", "https://image.prepladder.com/content/L1VdDMfZK9B28OQa1gzC1739958082.png", "https://image.prepladder.com/content/OHILFCfSCvetOp1JK0lk1739958114.png", "https://image.prepladder.com/content/V9YyZatom07KWiljuKj61739958191.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Erysipelas </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Cellulitis </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Carbuncle </strong><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Localized, sharply demarcated infection of upper dermis, often with broken skin.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Generalized deeper infection affecting <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Infection of hair follicles extending into surrounding and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Beta-hemolytic <em>Streptococcus pyogenes</em>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><em>Streptococcus pyogenes</em>, <em>Staphylococcus aureus</em>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><em>Staphylococcus aureus</em>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower limb, face, ear lobule, orbit.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower limb, upper limb, face, scrotum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nape of neck, back.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Erythematous, edematous rash; fever, leukocytosis, toxemia; raised <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> with sharp margins; <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> discharge; Milian's ear sign.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Diffuse expanding erythema, painful, swelling; fever, malaise, toxicity; lymphangitis; no clear edge or limit to infection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Red, painful nodule; tender, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> lesion; multiple draining sinuses; fever, lymphadenopathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Septicemia, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> gangrene, abscess, pneumonia, meningitis, lymphedema, <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> (20%).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pyogenic abscess, bacteremia, septicemia, local gangrene, <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Septicemia, abscess, necrosis, requiring possible <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or skin graft.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Broad-spectrum antibiotics; penicillins, clindamycin; long-term <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> for recurrence.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Broad-spectrum IV antibiotics; elevation, glycerine-magnesium <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> dressing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Control of diabetes; antibiotics; drainage, debridement, possible excision.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC/Dr. Thomas F. Sellers/Emory University\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Erysipelas#/media/File:Facial_erysipelas.jpg\" data-tags=\"\" height=\"1150\" src=\"https://image.prepladder.com/content/Bic2ldQqXbXeYBxhbkyK1739958048.png\" width=\"1076\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"డా. గన్నవరపు నరసింహమూర్తి,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:%E0%B0%95%E0%B0%BE%E0%B0%B2%E0%B0%BF%E0%B0%B2%E0%B1%8B_%E0%B0%95%E0%B0%A3%E0%B0%A4%E0%B0%BE%E0%B0%AA%E0%B0%AE%E0%B1%81_%28Cellulitis_of_leg%29.jpeg\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/L1VdDMfZK9B28OQa1gzC1739958082.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Medicalpal,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Carbuncle.jpg\" data-tags=\"\" height=\"1150\" src=\"https://image.prepladder.com/content/OHILFCfSCvetOp1JK0lk1739958114.png\" width=\"1287\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/K1EucyQQdbZnKxs6kecq1749106197.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 40 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 30 y/o woman sustains a stab wound in the neck that is located just above the cricoid cartilage but below the angle of the mandible. The injury is causing severe bleeding, and there is concern about the potential involvement of vital neck structures. Which neck zone is most relevant for assessing potential injury to major blood vessels and the trachea in this patient?", "options": [{"label": "A", "text": "Zone I", "correct": false}, {"label": "B", "text": "Zone II", "correct": true}, {"label": "C", "text": "Zone III", "correct": false}, {"label": "D", "text": "Zone IV", "correct": false}], "correct_answer": "B. Zone II", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ppFt3XwZPQvnWfFQcHgw1740111065.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Zone of Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone I</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the clavicles and the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Innominate vessels</li>\n<li>Origin of the common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</li>\n<li>Subclavian vessels and vertebral artery</li>\n<li>Brachial plexus</li>\n<li>Trachea</li>\n<li>Esophagus</li>\n<li>The <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> of the lung</li>\n<li>Thoracic duct</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Difficult <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exposure and access due to the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> and bony <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> structures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and the angle of the mandible.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carotid and vertebral arteries</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> veins</li>\n<li>Trachea</li>\n<li>Esophagus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Largest zone</li>\n<li>Most commonly injured</li>\n<li>Relatively easy access for clinical examination and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exploration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone III</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the angle of the <span class=\"customMeta\" data-dictid=\"55c062d44f16927771919375042b03\">mandible</span> and the base of the skull</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> and vertebral arteries</li>\n<li>Pharynx</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less accessible to physical examination</li>\n<li>Difficult to explore surgically.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AqwcbVC3xI6zzPCAzsBU1749048820.mp3", "video": ""}, {"text": "A 45-year-old male with a large right-sided pneumothorax and decreased breath sounds requires an intercostal chest drain (ICD). What is the most appropriate insertion site for the ICD?", "options": [{"label": "A", "text": "5th intercostal space, midclavicular line", "correct": false}, {"label": "B", "text": "2nd intercostal space, midaxillary line", "correct": false}, {"label": "C", "text": "5th intercostal space, anterior axillary line", "correct": true}, {"label": "D", "text": "2nd intercostal space, posterior axillary line", "correct": false}], "correct_answer": "C. 5th intercostal space, anterior axillary line", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CuzMDaHN7gPFCBf4pFbi1740111444.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/R2oGi9t2iuNTRNrbKmF51749050511.mp3", "video": ""}, {"text": "A 25 y/o male is brought to the ED after an explosion at a construction site. He was close to the blast and submerged in water. He has severe abdominal pain, difficulty hearing, shortness of breath, unstable vitals, and ruptured tympanic membranes on examination. Which organ is most likely to have sustained injury due to the blast?", "options": [{"label": "A", "text": "Lungs", "correct": false}, {"label": "B", "text": "Limbs", "correct": false}, {"label": "C", "text": "Gastrointestinal tract", "correct": true}, {"label": "D", "text": "Brain", "correct": false}], "correct_answer": "C. Gastrointestinal tract", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Air Blast Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Underwater Blast Injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most commonly injured:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (ear) - <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> and <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> damage are common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (ear) - More likely to occur when the head is submerged.</li>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> - When the head is not submerged.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most severely injured:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lungs - Blast lung injury is a common cause of delayed mortality and can cause <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> contusion, air embolism, and other damage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrointestinal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> - Underwater blasts can cause more severe GI injuries due to pressure effects on <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> organs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NVBnpIHuEgK84Zel0ok01749050318.mp3", "video": ""}, {"text": "A 32 y/o male presents after a car accident with severe chest and abdominal pain. O/E there are decreased breath sounds on the left side and abdominal tenderness. Chest X-ray reveals bowel gas patterns in the left thoracic cavity. A nasogastric tube is placed, and its tip is seen in the thoracic cavity. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Initiate conservative management and observe the patient.", "correct": false}, {"label": "B", "text": "Emergency laparotomy.", "correct": true}, {"label": "C", "text": "Order a CT scan of the chest and abdomen for further evaluation.", "correct": false}, {"label": "D", "text": "Schedule an elective surgery.", "correct": false}], "correct_answer": "B. Emergency laparotomy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DIAPHRAGMATIC INJURIES</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Penetrating Injury:</strong> Injuries below the fifth <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space suggest possible <span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\">diaphragmatic</span> injury and</li>\n<li><strong>Blunt Injury:</strong> Typically caused by compressive forces to the torso, often resulting in large <span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\">diaphragmatic</span> ruptures with <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents into the chest.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute Phase:</strong> <span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\">Diaphragmatic</span> injuries can be easily missed; often diagnosed during surgery or when complications arise.</li>\n<li><strong>Chest X-ray:</strong> May show a <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> stomach if a <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube is placed, especially in limited resource settings.</li>\n<li><strong>Thoracoscopy/Laparoscopy(VATS):</strong> The most accurate <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tools, with <span class=\"customMeta\" data-dictid=\"6aea253fe3169277719122813f8e25\">laparoscopy</span> offering additional evaluation and the possibility of immediate repair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Herniation of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Contents:</strong> Due to the pressure difference between the <span class=\"customMeta\" data-dictid=\"30e8f90f0e16927772006cb55500e7\">thorax</span> (negative pressure) and <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> (positive pressure).</li>\n<li><strong>Strangulation:</strong> High mortality if <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> contents become strangulated, especially if discovered late.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Operative Repair:</strong> Recommended for all <span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\">diaphragmatic</span> injuries.</li>\n<li><strong>Approach:</strong> <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">Penetrating</span> injuries should be repaired via the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and via the chest to rule out <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> <span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\">viscus</span> injuries.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ixuJ99cm3jHwZCOndqrC1749050190.mp3", "video": ""}, {"text": "A 45 y/o male presents to the emergency department after a motor vehicle accident. He is tachypneic, has severe chest pain, and paradoxical chest wall movement is noted on physical examination. His oxygen saturation is 85% on room air. A chest X-ray shows multiple rib fractures on the left side. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Tracheostomy", "correct": false}, {"label": "B", "text": "Intercostal tube drainage", "correct": false}, {"label": "C", "text": "Positive pressure ventilation", "correct": true}, {"label": "D", "text": "Thoracotomy", "correct": false}], "correct_answer": "C. Positive pressure ventilation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ss09PYxOdMxmB58Zls4A1749050072.mp3", "video": ""}, {"text": "A 45 y/o male is brought to the emergency room after a car accident with a penetrating injury to the left chest. An eFAST reveals fluid accumulation in the pericardial sac. Which of the following is not a component of Beck's triad, a classic finding in pericardial tamponade?", "options": [{"label": "A", "text": "Hypotension", "correct": false}, {"label": "B", "text": "Jugular venous distension", "correct": false}, {"label": "C", "text": "Bradycardia", "correct": true}, {"label": "D", "text": "Muffled heart sounds", "correct": false}], "correct_answer": "C. Bradycardia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/R6hR46Lfn39U2DBdx1NV1749049914.mp3", "video": ""}, {"text": "A 45 y/o man presents to the ED after a fall from a height. He is in severe respiratory distress, with rapid breathing. An x-ray film was taken of the chest which revealed the following. His blood pressure is rapidly dropping. Which of the following findings is least likely to be associated with this patient's condition?", "options": [{"label": "A", "text": "Hyper-resonance on the affected side", "correct": false}, {"label": "B", "text": "Tracheal deviation towards the opposite side", "correct": false}, {"label": "C", "text": "Bilateral equal breath sounds", "correct": true}, {"label": "D", "text": "Distended neck veins", "correct": false}], "correct_answer": "C. Bilateral equal breath sounds", "question_images": ["https://image.prepladder.com/content/ACW9494muhjmtIx1nNCJ1740111293.png"], "explanation_images": ["https://image.prepladder.com/content/mOWp41bAWnUdyZQryLle1740111352.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/R9bQ9LcaNJIoRlqclrHn1749049756.mp3", "video": ""}, {"text": "A 45 y/o male presents with severe chest trauma following a motor vehicle accident. After inserting a chest tube, the initial drainage is 1600 ml of blood, and he continues to drain over 200 ml/hour for the next three hours despite stabilization efforts. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Increase the suction on the chest tube", "correct": false}, {"label": "B", "text": "Administer intravenous fluids and continue observation", "correct": false}, {"label": "C", "text": "Perform an urgent thoracotomy", "correct": true}, {"label": "D", "text": "Insert a second chest tube", "correct": false}], "correct_answer": "C. Perform an urgent thoracotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Zf5ka8fk1vCLEaBTvdeA1749049598.mp3", "video": ""}, {"text": "A 34 y/o male presents to the ER after a high-speed car collision. He complains of severe shortness of breath, and physical examination reveals absent breath sounds on the lower left side with a dull note on percussion. The chest X-ray is given below. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Needle thoracostomy", "correct": false}, {"label": "B", "text": "ICD (Intercostal Drain) insertion", "correct": true}, {"label": "C", "text": "Immediate thoracotomy", "correct": false}, {"label": "D", "text": "Observation and serial chest X-rays", "correct": false}], "correct_answer": "B. ICD (Intercostal Drain) insertion", "question_images": ["https://image.prepladder.com/content/qb86HeEQcXEurwTPqkpR1740111149.png"], "explanation_images": ["https://image.prepladder.com/content/zbYnHX5tEYFPYgCqBZZM1740111214.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qxDxyQSldwJ7qhxQfuVv1749049253.mp3", "video": ""}, {"text": "A 55 y/o female was involved in a motor vehicle collision and now complains of severe anterior chest pain. O/E, she has point tenderness over the sternum and visible ecchymosis. What is the most likely associated injury that should be evaluated in a patient with a sternal fracture?", "options": [{"label": "A", "text": "Rib fractures", "correct": false}, {"label": "B", "text": "Pulmonary contusion", "correct": false}, {"label": "C", "text": "Myocardial contusion", "correct": true}, {"label": "D", "text": "Pneumothorax", "correct": false}], "correct_answer": "C. Myocardial contusion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/km5JLU819Kw7oou1oN7d1749049055.mp3", "video": ""}, {"text": "A 67 y/o man collapses and requires cardiopulmonary resuscitation (CPR) in the emergency department. After successful resuscitation, imaging reveals a rib fracture. Which rib is most commonly fractured during CPR?", "options": [{"label": "A", "text": "1st rib", "correct": false}, {"label": "B", "text": "2nd rib", "correct": false}, {"label": "C", "text": "5th rib", "correct": true}, {"label": "D", "text": "11th rib", "correct": false}], "correct_answer": "C. 5th rib", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PnGSiC655JCgLSuDIzOp1749048934.mp3", "video": ""}, {"text": "Match each description with the correct layer of the scalp: 1. Pericranium a) Richly vascularized 2. Aponeurosis b) Periosteum 3. Skin c) Danger zone 4. Connective Tissue d) Connects scalp muscles 5. Loose Areolar Connective Tissue e) Sebaceous glands", "options": [{"label": "A", "text": "1-d, 2-e, 3-c, 4-b, 5-a", "correct": false}, {"label": "B", "text": "1-c, 2-d, 3-b, 4-d, 5-a", "correct": false}, {"label": "C", "text": "1-e, 2-b, 3-a, 4-d, 5-c", "correct": false}, {"label": "D", "text": "1-b, 2-d, 3-e, 4-a, 5-c", "correct": true}], "correct_answer": "D. 1-b, 2-d, 3-e, 4-a, 5-c", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/V2wGhOVg8Llrxpafwwo71740110379.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The outermost layer; contains <strong>hair follicles and <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> glands</strong> that produce <span class=\"customMeta\" data-dictid=\"add57598af169277719845e7c30916\">sebum</span> for lubrication and protection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Connective Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dense layer with blood vessels, nerves, and fat; <strong>richly vascularized</strong>, leading to significant <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aponeurosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>A tough <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> layer (epicranial <span class=\"customMeta\" data-dictid=\"52cb21596b1692777181aa72f1feb5\">aponeurosis</span> or <span class=\"customMeta\" data-dictid=\"c39b17db831692777188ab2a71773e\">galea</span> aponeurotica); <strong>connects <span class=\"customMeta\" data-dictid=\"b1fd09e28c16927772034ee8e29d87\">frontalis</span> and <span class=\"customMeta\" data-dictid=\"74af2ca5f41692777194c1ddbf6f19\">occipitalis</span> muscles</strong> for <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Loose Areolar <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>It allows <span class=\"customMeta\" data-dictid=\"650eb29fb9169277719270ea0fbea5\">mobility</span> between the upper layers and the pericranium; it is considered a<strong> \"danger zone\"</strong> due to the potential for infection to spread via the <strong>emissary veins </strong>(from the <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> to the meninges).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pericranium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The innermost layer; the <strong>periosteum </strong>of the skull bones; provides nourishment and protection to the skull.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"><img alt=\"\" data-author=\"Henry Vandyke Carter, Henry Gray\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Gray1196.png\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/V2wGhOVg8Llrxpafwwo71740110379.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SpBJceVx6UgIPYBnh0Qy1749046369.mp3", "video": ""}, {"text": "In a patient with raised intracranial pressure (ICP) that remains elevated despite initial management, which of the following strategies is considered a second-tier therapy for refractory cases?", "options": [{"label": "A", "text": "Elevate the head end of the bed to 30°.", "correct": false}, {"label": "B", "text": "Administer mannitol to maintain serum osmolality &amp;lt; 320 mOsm/kg.", "correct": false}, {"label": "C", "text": "Perform a decompressive craniectomy.", "correct": true}, {"label": "D", "text": "Start therapeutic hyperventilation.", "correct": false}], "correct_answer": "C. Perform a decompressive craniectomy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:524px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positioning</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevate the head end of the bed to 30°: Promotes cerebral <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> and decreases ICP. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Drainage</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventriculostomy: Preferred method for draining <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) to reduce ICP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osmotherapy</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mannitol: Maintain <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &lt; 320 mOsm/kg to draw fluid out of the brain. <strong>(Option B ruled out)</strong></li>\n<li>2.5% Saline: <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">Hypertonic</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> solution to reduce cerebral oedema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoids</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dexamethasone: Used in conditions with <span class=\"customMeta\" data-dictid=\"c8013ecf46169277720128cab0a7b4\">vasogenic</span> oedema, such as brain tumours or brain abscesses.</li>\n<li>Avoid: Head injury, ischemic stroke, or hemorrhagic stroke as it may not be beneficial and can exacerbate some conditions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperventilation</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Therapeutic Hyperventilation: Used only for short periods to decrease CO₂ levels and reduce ICP.<strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ICP Monitoring</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventriculostomy: Preferred for continuous monitoring and <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> drainage.</li>\n<li>Fiberoptic intraparenchymal <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> monitor: Alternative for monitoring, especially in cases with <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> oedema or coagulopathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressor Therapy</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Medications: Phenylephrine, Dopamine, and <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">Norepinephrine</span> to increase mean <span class=\"customMeta\" data-dictid=\"9e831262a7169277718263c34e2dc1\">arterial pressure</span> and improve CPP.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XLeI7leUrqTbm3QLkqwE1749048618.mp3", "video": ""}, {"text": "A 35-year-old male in a high-speed crash presents with sudden loss of consciousness and remains comatose with neurological deficits, despite normal CT findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Contusion", "correct": false}, {"label": "B", "text": "Subdural hematoma", "correct": false}, {"label": "C", "text": "Diffuse axonal injury (DAI)", "correct": true}, {"label": "D", "text": "Epidural hematoma", "correct": false}], "correct_answer": "C. Diffuse axonal injury (DAI)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kWeYcnkUCxnhAfhQnvoT1749048499.mp3", "video": ""}, {"text": "A 60 y/o male suddenly experiences an intense headache, described as the worst headache of his life, followed by vomiting and photophobia. O/E he has neck stiffness and a dilated pupil on the right side. A CT scan reveals bleeding in the subarachnoid space. Which of the following is the most common cause of this condition?", "options": [{"label": "A", "text": "Hypertension", "correct": false}, {"label": "B", "text": "Intracranial aneurysm", "correct": true}, {"label": "C", "text": "Arteriovenous malformation (AVM)", "correct": false}, {"label": "D", "text": "Brain tumour", "correct": false}], "correct_answer": "B. Intracranial aneurysm", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gPa0nVwxiojkh3Wi7lNO1749048337.mp3", "video": ""}, {"text": "A 45 y/o male presents to the ED after a head injury sustained in a motor vehicle accident. He briefly lost consciousness at the scene but was alert and oriented upon arrival. A few hours later, he becomes progressively drowsy, and his right pupil is dilated. A CT scan shows the following findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subdural Hematoma (SDH)", "correct": false}, {"label": "B", "text": "Epidural Hematoma (EDH)", "correct": true}, {"label": "C", "text": "Intracerebral Haemorrhage (ICH)", "correct": false}, {"label": "D", "text": "Cerebral Contusion", "correct": false}], "correct_answer": "B. Epidural Hematoma (EDH)", "question_images": ["https://image.prepladder.com/content/NHshMbKhbIw68UwR9xtr1740110785.png"], "explanation_images": ["https://image.prepladder.com/content/k5EpX8jw9rNE7ntdY3oH1740110851.png", "https://image.prepladder.com/content/NeLZSzCfh7s9Ci7LQf141740110926.png", "https://image.prepladder.com/content/AaXipCpLlNldalRC5oMV1740110965.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Epidural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (EDH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subdural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (SDH) </strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rupture of an artery, often the <strong>middle meningeal artery, </strong>usually due to a skull fracture, commonly in the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Two contexts:</strong></p>\n<ul>\n<li>High-energy injury: Rupture of <strong>cortical surface vessels.</strong></li>\n<li>Low-energy injury: <strong>Venous bleeding,</strong> common in older adults on anticoagulants.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Classic: <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">Transient</span> loss of consciousness, <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval, rapid neurological decline.</li>\n<li>Headaches are common.</li>\n<li>Brain <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> signs: Contralateral hemiparesis, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> pupillary dilation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Variable presentation depending on injury severity and timing.</li>\n<li>Signs of raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure: Headache, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lentiform</strong> (lens-shaped or biconvex) <span class=\"customMeta\" data-dictid=\"1dfb6906b91692777189e0acce4f86\">hyperdense</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> between the skull and the brain.</p>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse <strong>concave </strong>hyperdense (acute), <span class=\"customMeta\" data-dictid=\"7f06e594de1692777190bfb4be030b\">isodense</span> (subacute), or <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> (chronic) lesions over the brain surface, often crossing <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines.</p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurosurgical emergency; requires immediate evacuation, usually by craniotomy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on size, location, and clinical status:</p>\n<p>1. Large or worsening hematomas: Urgent <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> by <span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\">craniotomy</span> or craniectomy.</p>\n<p>2. Smaller, stable bleeds: Conservative management initially, with surgery if needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Summary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>EDH often follows a predictable course with a <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SDH has a more variable presentation and distinct CT appearance.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cqO3YBop5Ae0Zd2G4Lbw1749048185.mp3", "video": ""}, {"text": "A 20 y/o male footballer sustains a blow to the head during a match. He did not lose consciousness but appeared confused and had difficulty recalling events before the impact. O/E, he is slow to respond and exhibits slight incoordination while walking. It is determined that he has suffered a concussion. Which of the following statements is most appropriate regarding his management?", "options": [{"label": "A", "text": "He should be allowed to return to play if he feels better after 15 minutes.", "correct": false}, {"label": "B", "text": "An immediate CT scan is required to rule out a cerebral contusion.", "correct": false}, {"label": "C", "text": "He should be monitored for second-impact syndrome if he returns to play prematurely.", "correct": true}, {"label": "D", "text": "A diagnosis of concussion is unlikely since there was no loss of consciousness.", "correct": false}], "correct_answer": "C. He should be monitored for second-impact syndrome if he returns to play prematurely.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jwX8gYBPjfgxR4DbeNyT1740110697.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Concussion </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defined as an alteration of consciousness due to a closed head injury, typically without <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> abnormalities.</li>\n</ul>\n<ul>\n<li>Confusion, amnesia, lethargy, distractibility, forgetfulness, slow interaction, emotional lability, <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> disturbance, and incoordination.</li>\n<li>Loss of consciousness is not required for diagnosis.</li>\n<li>Cerebral Autoregulation: May be impaired, increasing <span class=\"customMeta\" data-dictid=\"807e7281f1169277720228d2b0b559\">vulnerability</span> to repeat impacts.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Second Impact Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A rare but potentially fatal condition involving <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> brain <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> after a trivial repeat injury in someone with a recent <span class=\"customMeta\" data-dictid=\"48d609c8221692777184af30d81f54\">concussion</span> (fatal).</li>\n<li>Advisory: Individuals, especially athletes, should avoid returning to play until fully asymptomatic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Postconcussive Syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A set of long-term symptoms following a concussion.</li>\n<li>Somatic Symptoms: Headache, dizziness, hearing and vision disorders.</li>\n<li>Neurocognitive/Neuropsychological Symptoms: Difficulty with concentration and recall, insomnia, emotional lability, fatigue, depression, and personality changes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cerebral Contusions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly occur where the brain contacts the skull (eg., <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobes, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> poles).</li>\n<li>Can occur distant from the impact site due to brain movement (coup-contrecoup injury).</li>\n<li>CT Appearance: Heterogeneous, due to mixed injured brain matter and blood.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Management: Rarely require surgery but may be evacuated to reduce the mass effect.</li>\n</ul>\n<p><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Traumaticbraininjury2010.jpg\" data-tags=\"\" height=\"625\" src=\"https://image.prepladder.com/content/jwX8gYBPjfgxR4DbeNyT1740110697.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5smynHt9z8FEVb9eZFXo1749048020.mp3", "video": ""}, {"text": "A 68 y/o male on warfarin therapy presents to the emergency department after a fall from a ladder. He is fully conscious with a Glasgow Coma Scale (GCS) score of 15. He reports no loss of consciousness but is unable to recall events that happened before the fall. According to NICE guidelines, what is the most appropriate timing for a CT head scan in this patient?", "options": [{"label": "A", "text": "Immediate CT scan within 1 hour", "correct": false}, {"label": "B", "text": "CT scan within 8 hours", "correct": true}, {"label": "C", "text": "CT scan within 24 hours", "correct": false}, {"label": "D", "text": "No need for a CT scan; observation only", "correct": false}], "correct_answer": "B. CT scan within 8 hours", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neurological Observation in <span class=\"customMeta\" data-dictid=\"ba7c2a14e21692777200d3b3c73a35\">TBI</span> (Traumatic Brain Injury)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Crucial for managing moderate to severe TBI.</li>\n<li><strong>Key Assessments:</strong> Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale (GCS) score and <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> responses.</li>\n<li>Note the extent of <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> and <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia.</li>\n<li><strong>Initial:</strong> Half-hourly for 2 hours.</li>\n<li><strong>Follow-up:</strong> Hourly for 4 hours, then every 2 hours.</li>\n<li><strong>If Deterioration:</strong> Return to half-hourly and resume the original schedule.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NICE Guidelines for CT Head <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> in Adults </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT within 1 Hour: </strong><strong>(Option A ruled out)</strong></p>\n<ul>\n<li>GCS &lt; 13 at any time.</li>\n<li>GCS &lt; 15 at 2 hours post-injury.</li>\n<li>Focal neurological deficit.</li>\n<li>Suspicion of open, depressed, or <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> skull fracture.</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> episodes.</li>\n<li>Post-traumatic seizure.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>CT within 8 Hours:</strong></p>\n<ul>\n<li>Age &gt; 65.</li>\n<li>Coagulopathy (e.g., aspirin, <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">warfarin</span> use).</li>\n<li>Dangerous mechanism of injury.</li>\n<li>Retrograde <span class=\"customMeta\" data-dictid=\"8078d5919c1692777181166124343a\">amnesia</span> &gt; 30 minutes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NICE Guidelines for CT Head <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> in Children </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate CT:</strong></p>\n<ul>\n<li>Suspicion of non-accidental injury.</li>\n<li>First seizure.</li>\n<li>GCS &lt; 14, or &lt; 15 in children &lt; 1 year old.</li>\n<li>Signs of skull base fracture.</li>\n<li>Focal neurological deficit.</li>\n<li>Bruising, swelling, or <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> &gt; 5 cm in children &lt; 1 year old.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Additional Criteria (If Multiple Present):</strong></p>\n<ul>\n<li>Loss of consciousness &gt; 5 minutes.</li>\n<li>Abnormal drowsiness.</li>\n<li>≥4 <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> episodes.</li>\n<li>Dangerous mechanism of injury.</li>\n<li>Amnesia &gt; 5 minutes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Notes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These lists are not exhaustive; clinical judgment should be used in deciding whether to order a CT scan.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/m100v9r9nBe04KdYNSTK1749047012.mp3", "video": ""}, {"text": "A 32 y/o male presents to the emergency department after a high-impact motor vehicle accident. He complains of a severe headache, difficulty smelling, and clear fluid dripping from his nose. O/E, there is no external evidence of trauma, but the patient has a subconjunctival haemorrhage in the right eye. What is the most likely location of his skull fracture?", "options": [{"label": "A", "text": "Anterior cranial fossa", "correct": true}, {"label": "B", "text": "Middle cranial fossa", "correct": false}, {"label": "C", "text": "Posterior cranial fossa", "correct": false}, {"label": "D", "text": "Occipital bone", "correct": false}], "correct_answer": "A. Anterior cranial fossa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GkqZeYF5xMwK6fWMaUu51740110617.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fracture locations: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">Cranial</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">Fossa</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">Cranial</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">Fossa</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">Cranial</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">Fossa</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fx of <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fx of<strong> </strong>maxillary, sphenoid, or other <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> cavities.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CSF rhinorrhea</li>\n<li>Subconjunctival hemorrhage.</li>\n<li>Cranial nerve damage leading to:\n\t\t\t\t<ul>\n<li><strong>Anosmia</strong> (CN I damage)</li>\n<li>Partial or complete <strong>blindness</strong> ( CN II or III damage)</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CSF otorrhea</li>\n<li>Epistaxis</li>\n<li>Cranial nerve damage leading to:\n\t\t\t\t<ul>\n<li>Inward <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the eye (CN VI damage).</li>\n<li>Facial muscle weakness (CN VII damage).</li>\n<li>Hearing loss, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> (CN VIII damage).</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boggy <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the <span class=\"customMeta\" data-dictid=\"dddc9e4fbd16927771932a4f315ee5\">nape</span> of the neck.</li>\n<li>Cranial nerve damage leading to:\n\t\t\t\t<ul>\n<li>Difficulty swallowing, hoarseness, and muscle weakness (CN XI, X. XI damage).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wFLBphPGCYwVyyWXSlER1749046854.mp3", "video": ""}, {"text": "A 25 y/o male presents to the emergency department after being struck on the head by a small, high-velocity object. He is conscious but reports a severe headache. A CT scan reveals a depressed skull fracture with evidence of intracranial air. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Conservative management with observation.", "correct": false}, {"label": "B", "text": "Surgical exploration and elevation of the depressed fracture.", "correct": true}, {"label": "C", "text": "Intravenous antibiotics without surgery.", "correct": false}, {"label": "D", "text": "Application of a pressure dressing to the fracture site.", "correct": false}], "correct_answer": "B. Surgical exploration and elevation of the depressed fracture.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically caused by small objects impacting the skull at high velocity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually compound/open fractures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Risks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of infection</li>\n<li>Neurological deficits</li>\n<li>Late-onset epilepsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exploration and elevation.</li>\n<li>Intracranial air (indicating a <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> breach) necessitates surgery.</li>\n<li>Open fractures (e.g., involving air sinuses) are managed with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exploration and <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zlAlLIyMopjqdqme5ofj1749046611.mp3", "video": ""}, {"text": "A 35 y/o man with a head injury, scalp laceration, headache, skull depression, and CT showing an intracranial hematoma and frontal sinus involvement presents to the emergency department. What is the most appropriate management?", "options": [{"label": "A", "text": "Monitor and allow spontaneous healing with no immediate intervention.", "correct": false}, {"label": "B", "text": "Order a follow-up CT scan in 24 hours to reassess the extent of the injuries.", "correct": false}, {"label": "C", "text": "Perform operative debridement and repair the scalp, and consider craniotomy", "correct": true}, {"label": "D", "text": "Administer antibiotics and provide supportive care without any surgical intervention.", "correct": false}], "correct_answer": "C. Perform operative debridement and repair the scalp, and consider craniotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2qDQC5RXY93MEtuVsfwY1740110464.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Closed Skull Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Open (Compound) Skull Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Overlying Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Skin remains intact; brain and inner structures are not exposed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Skin is disrupted; the brain may be exposed, increasing infection risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Typically heals on its own; monitoring for complications is key.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>It involves <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> repair, <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> debridement, and preventing infection.</p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Craniotomy Indications:</strong>\n<ul>\n<li>Depression greater than <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> thickness.</li>\n<li>Intracranial hematoma.</li>\n<li>Frontal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> involvement.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/L7AF9xZPwcVpDgrwpadK1749046491.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the given instrument's tip resembles the given image?", "options": [{"label": "A", "text": "Mayo's Towel Clip", "correct": false}, {"label": "B", "text": "Rampley's Sponge Holding Forceps", "correct": true}, {"label": "C", "text": "Moynihan's Tetra-Towel Clip", "correct": false}, {"label": "D", "text": "Doyen's Towel Clip", "correct": false}], "correct_answer": "B. Rampley's Sponge Holding Forceps", "question_images": ["https://image.prepladder.com/content/NVg9ah1Nj2gMMvUygxJp1740045799.png"], "explanation_images": ["https://image.prepladder.com/content/gxocBq8F46kSPaCJcCHC1740045728.png", "https://image.prepladder.com/content/BC3Hup5z4lGONpGFbGog1740045846.png", "https://image.prepladder.com/content/JM6aGhChLaewmVlZAgb81740045872.png", "https://image.prepladder.com/content/XLLTCIuF6MfOqA70UD6D1740045896.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849835.mp3", "video": ""}, {"text": "Match the following Blade numbers with their uses given. 1. No. 11 a) Skin incisions in major surgeries 2. No. 12 b) Used in plastic surgery 3. No. 15 c) Incision and drainage of abscesses 4. No. 22 d) Used for tonsillectomy", "options": [{"label": "A", "text": "1-d, 2-c, 3-a, 4-b", "correct": false}, {"label": "B", "text": "1-a, 2-b, 3-d, 4-c", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-b, 4-d", "correct": false}, {"label": "D", "text": "1-c, 2-d, 3-b, 4-a", "correct": true}], "correct_answer": "D. 1-c, 2-d, 3-b, 4-a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JajQmaLj3AGKytvQ2Fgv1740045943.png", "https://image.prepladder.com/content/dmURDZEgtAWHIx7ANv471740046006.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Blade Number</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>No. 11</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Stab knife, used for <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of abscesses, and small incisions (e.g., drains).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>No. 12</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Curved blade, used for tonsillectomy; <span class=\"customMeta\" data-dictid=\"68598f613b16927771853d5009f3da\">cutting edge</span> faces the surgeon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>No. 15</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Used in plastic surgery, head and neck surgeries, and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> surgeries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Nos. 20, 22, 24</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Used for skin incisions in major surgeries like laparotomy, thoracotomy, craniotomy, and limb surgeries.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Saltanat ebli \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Scalpel#/media/File:Scalpel_blade_sizes.JPG\" data-tags=\"\" src=\"https://image.prepladder.com/content/JajQmaLj3AGKytvQ2Fgv1740045943.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849836.mp3", "video": ""}, {"text": "Which of the following statements is FALSE?", "options": [{"label": "A", "text": "The needle holder is sterilized by an autoclave.", "correct": false}, {"label": "B", "text": "Toothed dissecting forceps are used to hold delicate structures like nerves and vessels.", "correct": true}, {"label": "C", "text": "Curved needle holders provide better maneuverability in deep areas like the pelvis.", "correct": false}, {"label": "D", "text": "Plain non-toothed dissecting forceps are used to hold friable structures like peritoneum and tendons.", "correct": false}], "correct_answer": "B. Toothed dissecting forceps are used to hold delicate structures like nerves and vessels.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NmmNgjkjGjD0f4MIwkMR1740046044.png", "https://image.prepladder.com/content/g6FinO2Tnfxd5JHPOWsD1740046079.png", "https://image.prepladder.com/content/Tp7MmDj8DzjaeLoUrGCx1740046120.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>INSTRUMENT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>NEEDLE HOLDER FORCEPS</u></strong></p>\n<br/>\n<img alt=\"\" data-author=\"Rschiedon\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Needle_holder#/media/File:Naaldvoerder_Mayo-hegar.jpg\" data-tags=\"\" height=\"162\" src=\"https://image.prepladder.com/content/NmmNgjkjGjD0f4MIwkMR1740046044.png\" width=\"300\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> blades with criss-cross serrations and a <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> for grip.</li>\n<li><strong>Length of handle: Blade Ratio</strong>: 4:1.</li>\n<li><strong>Types</strong>: Straight or curved</li>\n<li><strong>Needle Positioning</strong>: Needle held at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> 2/3 and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> 1/3 for control.</li>\n<li><strong>Handling</strong>: Held between thumb and ring finger.</li>\n<li><strong>Curved Holders</strong>: For better maneuverability in deep areas (pelvis, thorax). <strong>(Option C ruled out)</strong></li>\n<li><strong>Sterilization</strong>: Autoclave. <strong>(Option A ruled out)</strong></li>\n<li><strong>Tungsten-Carbide Coating</strong>: Increases durability.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>PLAIN DISSECTING FORCEPS</u></strong></p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/g6FinO2Tnfxd5JHPOWsD1740046079.png\" width=\"300\"/><br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to hold delicate, soft, and <span class=\"customMeta\" data-dictid=\"8b9056372a169277720355419379ac\">friable</span> structures like peritoneum, vessels, bowel, nerves, and tendons. <strong>(Option D ruled out)</strong></li>\n<li>Not suitable for holding skin or tough structures.</li>\n<li>Hold, fix, steady, or stretch tissues.</li>\n<li>Hold and <span class=\"customMeta\" data-dictid=\"19faab76c9169277718315b6ee8434\">cauterize</span> small <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>TOOTHED FORCEPS</u></strong></p>\n<br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/Tp7MmDj8DzjaeLoUrGCx1740046120.png\" width=\"200\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to hold skin and tough structures like <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and aponeurosis.</li>\n<li>Not used for delicate structures like the bowel, vessels, or nerves. <strong>(Option B)</strong></li>\n<li>May have one-in-two or two-in-three teeth.</li>\n<li><strong>Adson’s Forceps</strong>: Small, fine <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> for delicate work; can be toothed or non-toothed.</li>\n<li><strong>Victor–Bonney’s Forceps</strong>: Heavy-toothed dissecting forceps.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849837.mp3", "video": ""}, {"text": "Match the following instruments with their corresponding images: 1) a) Bone nibbler 2) b) Humby’s Knife 3) c) Rib Shear 4) d) Bone Cutter", "options": [{"label": "A", "text": "1-a. 2-d, 3-c, 4-b", "correct": false}, {"label": "B", "text": "1-b, 2-c, 3-d, 4-a", "correct": true}, {"label": "C", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-d, 4-b", "correct": false}], "correct_answer": "B. 1-b, 2-c, 3-d, 4-a", "question_images": ["https://image.prepladder.com/notes/KhVVHvu83sqd8dXKvmXR1747137284.png", "https://image.prepladder.com/content/8zmLV1rvNYaYFYPjyynQ1740046259.png", "https://image.prepladder.com/content/R5qu08QxtgpqNfiNUB0x1740046305.png", "https://image.prepladder.com/content/DEmCeHjIna9CTXR4K2cA1740046339.png"], "explanation_images": ["https://image.prepladder.com/content/EyZsXxQggTDEUFl1K1T71740046184.png", "https://image.prepladder.com/content/eXcRXjRnZln2dEaFee9M1740046269.png", "https://image.prepladder.com/content/tS8eqGIdUWOIeJ0JlaGU1740046293.png", "https://image.prepladder.com/content/yRlNrh2UlV73gWMISHnh1740046345.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>INSTRUMENT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>HUMBY’S KNIFE</u></strong></p>\n<br/>\n<img alt=\"\" data-author=\"Faisal Ameer, Arun K Singh, Kumar Sandeep\" data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://www.researchgate.net/figure/Comparison-of-major-modifications-of-free-hand-knives_fig14_255986865\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/EyZsXxQggTDEUFl1K1T71740046184.png\" width=\"400\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for harvesting split skin grafts, usually from the thigh.</li>\n<li>Parts: Stout handle with two flat blades, one fixed and one rotatable.</li>\n<li>Disposable blade is secured with knobs for grafting.</li>\n<li>Firm pressure with sawing action is used for skin harvesting.</li>\n<li>Punctate <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> confirms a successful graft.</li>\n<li>Graft placed on a <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> board with small cuts to prevent seroma.</li>\n<li>Fixed to the recipient site with sutures or staples.</li>\n<li>Inspected on the 5th day for <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> take-up.</li>\n<li>The donor site is inspected after 10 days and left open.</li>\n<li>Graft stages: <span class=\"customMeta\" data-dictid=\"caf2ca0fb616927771954e2a23e7db\">plasmatic</span> imbibition, revascularization, circulation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>RIB SHEAR</u></strong></p>\n<br/>\n<img alt=\"\" data-author=\"Laika ac from USA\" data-hash=\"\" data-license=\"CC BY-SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Laika_ac_19th_Century_Rib_Shears_%2810441699456%29.jpg\" data-tags=\"\" height=\"59\" src=\"https://image.prepladder.com/content/eXcRXjRnZln2dEaFee9M1740046269.png\" width=\"300\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Large rough handles for better grip.</li>\n<li>One blade is <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> with grooves and serrations, used as a protector for adjacent tissues.</li>\n<li>The other blade is sharp and cuts the rib.</li>\n<li>Designed to cut the rib from the front.</li>\n<li>Used specifically for rib resection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>BONE / RIB CUTTER</u></strong></p>\n<br/>\n<img alt=\"\" data-author=\"Bszsurgico\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Bone_cutter#/media/File:Bone_cutter.jpg\" data-tags=\"\" height=\"222\" src=\"https://image.prepladder.com/content/tS8eqGIdUWOIeJ0JlaGU1740046293.png\" width=\"300\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short blades with sharp, firm cutting edges for cutting bones.</li>\n<li>Stout handle with ridges for a firm grip.</li>\n<li>Provides <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> mechanical force for cutting bones or bone spurs.</li>\n<li>Some models include a leverage system for enhanced performance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>BONE NIBBLER</u></strong></p>\n<img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Double_action_bone_nibbler.jpg\" data-tags=\"\" height=\"141\" src=\"https://image.prepladder.com/content/yRlNrh2UlV73gWMISHnh1740046345.png\" width=\"300\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sharp edges at the tip with <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> blades.</li>\n<li>Available in single action or double action joint.</li>\n<li>Used to nibble bone into pieces.</li>\n<li>Commonly used in craniectomy, rib resection, and small bone amputations.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849838.mp3", "video": ""}, {"text": "A 60 year old male presents with rectal bleeding and a history of hemorrhoids. His physician decides to perform a proctoscopy using Kelly's rectal speculum to assess the cause of the bleeding. Which of the following is NOT an indication of the use of Kelly's rectal speculum?", "options": [{"label": "A", "text": "Diagnosing piles", "correct": false}, {"label": "B", "text": "Treating partial rectal prolapse", "correct": false}, {"label": "C", "text": "Treating acute anal fissure", "correct": true}, {"label": "D", "text": "Assessing rectal carcinoma", "correct": false}], "correct_answer": "C. Treating acute anal fissure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sLAzfT44RQUbqJ4TlMA81740046471.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic</strong>:</p>\n<ul>\n<li>Piles <strong>(Option A ruled out)</strong></li>\n<li>Fissure in ano</li>\n<li>Polyps</li>\n<li>Stricture</li>\n<li>Internal opening in fistula</li>\n<li>Carcinoma or any rectal bleeding<strong> (Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapeutic</strong>:</p>\n<ul>\n<li>Injection therapy for partial <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> or piles <strong>(Option B ruled out)</strong></li>\n<li>Cryotherapy for piles</li>\n<li>Banding for piles</li>\n<li>Polypectomy</li>\n<li>Biopsy for <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> or anorectum.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849839.mp3", "video": ""}, {"text": "A 45 year old woman undergoes surgery for varicose veins involving the stripping of the long saphenous vein using a Mayo vein stripper. Post-operatively, she complains of pain and tingling along the medial aspect of her leg. Which nerve is most commonly damaged during the stripping of the long saphenous vein?", "options": [{"label": "A", "text": "Sciatic nerve", "correct": false}, {"label": "B", "text": "Tibial nerve", "correct": false}, {"label": "C", "text": "Saphenous nerve", "correct": true}, {"label": "D", "text": "Femoral nerve", "correct": false}], "correct_answer": "C. Saphenous nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2S2EXFOknW8zR6p1ibEx1740046539.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hGeLfpGGWuJVLU4zRDm31749027740.mp3", "video": ""}, {"text": "Match the following instruments with their respective images: 1. Kocher’s forceps A) 2. Mosquito forceps B) 3. Allis forceps C) 4. Babcock’s forceps D)", "options": [{"label": "A", "text": "1-A,2-B,3-C,4-D", "correct": true}, {"label": "B", "text": "1-B,2-C,3-A,4-D", "correct": false}, {"label": "C", "text": "1-C,2-B,3-1,4-D", "correct": false}, {"label": "D", "text": "1-D,2-A,3-B,4-C", "correct": false}], "correct_answer": "A. 1-A,2-B,3-C,4-D", "question_images": ["https://image.prepladder.com/content/iLrTh8uYMo2VFCK7BcbB1740046640.png", "https://image.prepladder.com/content/hEnjP8J9XEnLOzkSS9pL1740046720.png", "https://image.prepladder.com/content/yzPjhjZoiHiBDtYExEFV1740046801.png", "https://image.prepladder.com/notes/Fw858yTVIMgnZZDgf69G1749447153.png"], "explanation_images": ["https://image.prepladder.com/content/As2rV5wMIFhvPxLDR0jJ1740046646.png", "https://image.prepladder.com/content/Pt1SOtuk57w9hWfbjbRA1740046728.png", "https://image.prepladder.com/content/Pj6rilDyggijIL39LofT1740046896.png", "https://image.prepladder.com/content/RgfBZLo1b4W1RPIuSfys1740046808.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849841.mp3", "video": ""}, {"text": "Which of the following is used to retract the scapula during thoracotomy?", "options": [{"label": "A", "text": "No options available", "correct": false}], "correct_answer": "Unknown", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sHpG3PDUx3EzIMTXq3zT1740047185.png", "https://image.prepladder.com/content/Ao8ND9nGK4UJSI7Fv6Fc1740047148.png", "https://image.prepladder.com/content/0DXQmOchKNmX4HNhUB5L1740047079.png", "https://image.prepladder.com/content/hTNMw8DUMRKIGPwv3OHh1740047223.png", "https://image.prepladder.com/content/1V6gJOng8IcrCv4fAh5Z1740047251.png", "https://image.prepladder.com/content/Ms7agQAklr7SUnxCUM6T1740047318.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849842.mp3", "video": ""}, {"text": "Identify the following instrument:", "options": [{"label": "A", "text": "Payr’s gastric occlusion clamp", "correct": false}, {"label": "B", "text": "Potts bulldog clamp", "correct": true}, {"label": "C", "text": "Doyens intestinal occlusion clamp", "correct": false}, {"label": "D", "text": "Lights bulldog clamp", "correct": false}], "correct_answer": "B. Potts bulldog clamp", "question_images": ["https://image.prepladder.com/content/ocqJWT7Wl03facWlYiDC1740047576.png"], "explanation_images": ["https://image.prepladder.com/content/JzHXotY2OhLNbA3KCQcl1740047446.png", "https://image.prepladder.com/content/0CcqfIDZNsVRNSy2oMOm1740047487.png", "https://image.prepladder.com/content/oPb2dKDmJZIvennquw7F1740047525.png", "https://image.prepladder.com/content/msCpZheZyeBrYHo4jFwF1740047551.png", "https://image.prepladder.com/content/LP4UFJDVIXND6sOfWueJ1740047598.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849843.mp3", "video": ""}, {"text": "Which of the following statements correctly differentiates Mayo scissors from Metzenbaum scissors?", "options": [{"label": "A", "text": "Mayo scissors are designed for delicate dissection while Metzenbaum scissors are sturdy and suited for cutting dense tissues.", "correct": false}, {"label": "B", "text": "Mayo scissors are sturdy and suitable for cutting dense tissues, while Metzenbaum scissors are ideal for blunt dissection and fine tissue work.", "correct": true}, {"label": "C", "text": "Metzenbaum scissors are used for cutting dense tissues, while Mayo scissors are for blunt dissection in thoracic surgeries.", "correct": false}, {"label": "D", "text": "Metzenbaum scissors are suitable for cutting sutures and are sturdy, whereas Mayo scissors are delicate and used for blunt dissection", "correct": false}], "correct_answer": "B. Mayo scissors are sturdy and suitable for cutting dense tissues, while Metzenbaum scissors are ideal for blunt dissection and fine tissue work.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sjrqWKUQYaNl0GFA85C81740047636.png", "https://image.prepladder.com/content/ABwZT4ndZ6PeOVIiA8aD1740047667.png", "https://image.prepladder.com/content/ZMsfL8U0FGx9CAXHgWmC1740047682.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:1200px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Scissors Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Design</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Alternative Names</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mayo Scissors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sturdy and robust, suitable for cutting dense tissues.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appendectomy.</li>\n<li>Herniotomy.</li>\n<li>Exploratory laparotomy.</li>\n<li>Mastectomy.</li>\n<li>Gynecological surgeries (e.g., dissecting tendons, and <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> structures).</li>\n<li>Cutting ligaments (e.g., laryngectomy, thyroidectomy).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often called \"suture scissors\".</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Armin\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Mayo_scissors#/media/File:Mayo_surgical_scissors.jpg\" data-tags=\"\" height=\"143\" src=\"https://image.prepladder.com/content/sjrqWKUQYaNl0GFA85C81740047636.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Metzenbaum Scissors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delicate and ideal for <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> dissection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blunt dissection.</li>\n<li>Incising deep rib bed <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> in <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> procedures.</li>\n<li>Tonsillectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly known as \"Metz\" or \"Lahey forceps\".</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Saltanat ebli \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Metzenbaum_scissors_04.jpg\" data-tags=\"\" height=\"191\" src=\"https://image.prepladder.com/content/ABwZT4ndZ6PeOVIiA8aD1740047667.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lister <span class=\"customMeta\" data-dictid=\"4f62176420169277718214bfcafae5\">Bandage</span> Scissors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Features a longer, blunt-tipped bottom blade paired with an angled sharp upper blade for secure and precise cutting.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cutting bandages on the skin.</li>\n<li>Dressings.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Saltanat ebli \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://en.wikipedia.org/wiki/Bandage_scissors#/media/File:Bandage_Scissors.JPG\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/ZMsfL8U0FGx9CAXHgWmC1740047682.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849844.mp3", "video": ""}, {"text": "Which of the following instruments is used to assess the patency of CBD?", "options": [{"label": "A", "text": "Bakes Dilator", "correct": true}, {"label": "B", "text": "Tracheal Dilator", "correct": false}, {"label": "C", "text": "Urethral Dilator", "correct": false}, {"label": "D", "text": "Filiform Bougies", "correct": false}], "correct_answer": "A. Bakes Dilator", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZukPbb4J9RjElgJPrizP1740047744.png", "https://image.prepladder.com/content/zeMjlCHXFqp6AAxuLOZV1740047771.png", "https://image.prepladder.com/content/kUayyWUtI2DaZK6einva1740047790.png", "https://image.prepladder.com/content/rfyEHEqJKXMrRT5D58051740047824.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bakes <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">Dilator</span> / Bakes <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">dilator</span> </strong><br/>\n<strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A long, malleable, <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> instrument with a club-shaped tip.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/ZukPbb4J9RjElgJPrizP1740047744.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assessing patency/blockage of the CBD and duodenal papilla.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tracheal <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">Dilator</span> </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to widen the <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> opening during tracheostomy.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/zeMjlCHXFqp6AAxuLOZV1740047771.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of a <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">tracheostomy</span> tube.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Urethral <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">Dilator</span> </strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A long, curved, <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> instrument with a <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> tip.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/kUayyWUtI2DaZK6einva1740047790.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urethral dilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849845.mp3", "video": ""}, {"text": "Which laparoscopic instrument is used to establish pneumoperitoneum?", "options": [{"label": "A", "text": "Hasson Cannula/Trocar", "correct": false}, {"label": "B", "text": "Veress Needle", "correct": true}, {"label": "C", "text": "Laparoscopic Camera", "correct": false}, {"label": "D", "text": "Secondary Trocar", "correct": false}], "correct_answer": "B. Veress Needle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KuwQytSa6x31exWKe1rj1740047968.png", "https://image.prepladder.com/content/8R3JvuVPx1fNEkhjOjVG1740047998.png", "https://image.prepladder.com/content/qoqtssIMkEmU2l9g2zdL1740048169.png", "https://image.prepladder.com/content/iaKUm7fHeZoePKKLTTfL1740048203.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Veress Needle</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spring-loaded with a sharp outer <span class=\"customMeta\" data-dictid=\"bbf8b48b88169277718291fbdbac47\">bevel</span> and <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> inner stylet. Inserted at Palmer's point (3 cm below the left <span class=\"customMeta\" data-dictid=\"ece2c20c001692777185d9ca0c08db\">costal</span> margin).</p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"Lx zander \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://www.wikidata.org/wiki/Q2827881#/media/File:Verres_Needle.jpg\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/KuwQytSa6x31exWKe1rj1740047968.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Establishes <span class=\"customMeta\" data-dictid=\"8c36ab9b0516927771962c88c4ada4\">pneumoperitoneum</span> for <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> procedures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hasson Cannula/Trocar</strong></p>\n<p><strong>(Option A </strong><strong>ruled out</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A blunt-tipped <span class=\"customMeta\" data-dictid=\"926ccfdbd8169277720055492d19e0\">trocar</span> is inserted through a surgically created opening, typically at the umbilicus.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/8R3JvuVPx1fNEkhjOjVG1740047998.png\" width=\"400\"/></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for open technique access in laparoscopy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Trocar (Secondary) </strong></p>\n<p><strong>(Option D </strong><strong>ruled out</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inserted under direct <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> vision after <span class=\"customMeta\" data-dictid=\"8c36ab9b0516927771962c88c4ada4\">pneumoperitoneum</span> is established. Smaller diameters are preferred.</p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/qoqtssIMkEmU2l9g2zdL1740048169.png\" width=\"400\"/></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of additional instruments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Laparoscopic Camera </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides a magnified, <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">real-time</span> view of the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> field.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/iaKUm7fHeZoePKKLTTfL1740048203.png\" width=\"400\"/><br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualises the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> field during <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> surgery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/849846.mp3", "video": ""}, {"text": "Which of the following best describes the safety protocols for electrosurgery using diathermy?", "options": [{"label": "A", "text": "Always use the maximum current setting to ensure effectiveness and minimize burns.", "correct": false}, {"label": "B", "text": "Bipolar diathermy is preferred in patients with implants.", "correct": true}, {"label": "C", "text": "Monopolar diathermy is preferred near vital &amp;amp; sensitive structures.", "correct": false}, {"label": "D", "text": "There is no need to use smoke extractors as the risk of exposure to surgical smoke is minimal.", "correct": false}], "correct_answer": "B. Bipolar diathermy is preferred in patients with implants.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tT56J7oEg9AK9OiHjNSH1740048316.png", "https://image.prepladder.com/content/627dmOK5gl8XXcqBIMq81740048436.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Equipment Check: Verify settings before use.</li><li>↳ Lowest Effective Setting : Use minimal current necessary. (Option A ruled out)</li><li>↳ :</li><li>↳ (Option A ruled out)</li><li>↳ Caution with Metal Objects : Be careful near other metal instruments.</li><li>↳ :</li><li>↳ Intermittent Use : Apply in short, controlled bursts.</li><li>↳ :</li><li>↳ Bipolar Preference: Prefer bipolar in sensitive areas or for patients with implants. (Option B)</li><li>↳ (Option B)</li><li>↳ Smoke Evacuation: Use smoke extractors to reduce exposure to surgical smoke. (Option D ruled out)</li><li>↳ (Option D ruled out)</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1wbUVquxAbnhzfBdl3mC1749028297.mp3", "video": ""}, {"text": "Which of the following statements is false regarding the given instrument?", "options": [{"label": "A", "text": "Uses pressure and continuous bipolar energy for vessel sealing.", "correct": false}, {"label": "B", "text": "Achieves burst pressures over three times the normal systolic blood pressure.", "correct": false}, {"label": "C", "text": "Sealing time is 8-10 seconds.", "correct": true}, {"label": "D", "text": "Denatures collagen and elastin in vessel walls, forming a solid tissue seal.", "correct": false}], "correct_answer": "C. Sealing time is 8-10 seconds.", "question_images": ["https://image.prepladder.com/content/SjNtUZVIstHU1aitb84O1740048487.png"], "explanation_images": ["https://image.prepladder.com/content/73omMIqfSgHj6ZN3n3Vg1740048520.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vUSV3jtPXAcOMR3lTMId1749028475.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45 y/o male patient is admitted to the ICU following a major road traffic accident, resulting in multiple fractures and abdominal injuries. The patient is currently unable to take oral nutrition. He is expected to require enteral feeding for more than 3 weeks. Imaging studies reveal delayed gastric emptying and significant gastric distension. What is the most appropriate route for enteral nutrition in this patient?", "options": [{"label": "A", "text": "Nasogastric tube", "correct": false}, {"label": "B", "text": "Ryles tube", "correct": false}, {"label": "C", "text": "Feeding gastrostomy", "correct": false}, {"label": "D", "text": "Feeding jejunostomy", "correct": true}], "correct_answer": "D. Feeding jejunostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BbB9rOoHAlla0bEd6J5F1740044260.png", "https://image.prepladder.com/content/7Ek7q3TEcxrviVeTbSTC1740044283.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UmyfPdAPq8Usvtch8g0C1749042304.mp3", "video": ""}, {"text": "A 38-year-old male involved in a motor vehicle accident has been in the ICU for several days with multiple injuries including head and abdominal trauma. The ICU team is considering starting enteral feeding. Which of the following findings would most likely contraindicate the initiation of enteral nutrition in this patient?", "options": [{"label": "A", "text": "Inflammatory bowel disease", "correct": false}, {"label": "B", "text": "Distal low-output enterocutaneous fistula", "correct": false}, {"label": "C", "text": "Proximal small intestinal fistula", "correct": true}, {"label": "D", "text": "Constipation", "correct": false}], "correct_answer": "C. Proximal small intestinal fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein-energy <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">malnutrition</span> with inadequate oral intake</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or ileus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysphagia except for liquids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe diarrhea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Major trauma or surgery when returning to dietary <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> is prolonged</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal small intestinal fistula<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe Pancreatitis</p>\n<p><strong>(</strong>the food particles stimulate the release of pancreatic enzymes, ultimately worsening the symptoms.)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal low-output <span class=\"customMeta\" data-dictid=\"3f5075355d1692777187d4d95308be\">enterocutaneous</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GI bleed</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tube-Related Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malposition</li>\n<li>Displacement</li>\n<li>Blockage</li>\n<li>Leakage</li>\n<li>Erosion of skin and mucosa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal Complications (due to high osmotic load)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diarrhea</li>\n<li>Abdominal cramps</li>\n<li>Aspiration</li>\n<li>Constipation (Option D ruled out)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dyselectrolytemia (increased risk)</li>\n<li>Deficiency of vitamins, minerals, and trace elements</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infective Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endogenous</li>\n<li>Exogenous</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/i5RFKZRs5jzVIAanQCT81749042513.mp3", "video": ""}, {"text": "A 45-year-old male recovering from gastrointestinal surgery is on total parenteral nutrition (TPN). Initially, he was receiving a 2-in-1 TPN formulation. Due to ongoing nutritional needs, the medical team switches him to a 3-in-1 TPN formulation. Which component is newly included in the 3-in-1 formulation that was not in the 2-in-1?", "options": [{"label": "A", "text": "Amino acids", "correct": false}, {"label": "B", "text": "Dextrose", "correct": false}, {"label": "C", "text": "Lipids", "correct": true}, {"label": "D", "text": "Fiber", "correct": false}], "correct_answer": "C. Lipids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3 in 1 <span class=\"customMeta\" data-dictid=\"cbc39c70db169277720312f2d6905b\">formulation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 in 1 formulation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Solutions with lipids <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Solutions without lipids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>60/20/20</strong></p>\n<ul>\n<li>60% by dextrose</li>\n<li>20% by <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</li>\n<li>20% by fat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>75/25</strong></p>\n<ul>\n<li>75% by <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> <strong>(OPTION B ruled out)</strong></li>\n<li>25% by <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids <strong>(OPTION A ruled out)</strong></li>\n<li>No lipids used <strong>(OPTION C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fiber is absent in both the formulations <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ACFgdCxMT4z2xpVrq6n71747155285.mp3", "video": ""}, {"text": "A 72-year-old male with severe pancreatitis is initiated on total parenteral nutrition (TPN) due to his inability to tolerate enteral feeding. Shortly after the central venous catheter is inserted, he complains of sudden onset shortness of breath and pleuritic chest pain. On examination, his breath sounds are decreased on the same side of the catheter insertion. What is the most likely complication that has occurred?", "options": [{"label": "A", "text": "Catheter-related sepsis", "correct": false}, {"label": "B", "text": "Catheter related thrombosis", "correct": false}, {"label": "C", "text": "Dyselectrolytemia", "correct": false}, {"label": "D", "text": "Pneumothorax", "correct": true}], "correct_answer": "D. Pneumothorax", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">Insertion</span> Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pneumothorax (most dangerous)</li>\n<li>Misplacement of catheter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Line-Related Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sepsis (most common)</li>\n<li>Thrombosis (more common with long-term <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> use)</li>\n<li>Electrolyte imbalances (e.g., <span class=\"customMeta\" data-dictid=\"acd4d513d216927771971a62ca95db\">refeeding</span> syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood sugar derangements (hyperglycemia, hypoglycemia)</li>\n<li>Liver dysfunction</li>\n<li>Metabolic bone disease</li>\n<li>Vitamin deficiencies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zlCZizlqnpWQgcUDN9Pm1749042656.mp3", "video": ""}, {"text": "A 45 year old male severely malnourished patient with a history of chronic alcoholism and recent weight loss is admitted in the hospital. After stabilization, he is started on a high-calorie enteral feeding regimen to address his nutritional deficiencies. Within 48 hours of initiating feeding, he begins to have muscle weakness, difficulty in breathing and is confused. Which of the following electrolyte abnormalities in the blood is least likely to be associated with his current condition?", "options": [{"label": "A", "text": "Hypophosphatemia", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": false}, {"label": "C", "text": "Hypomagnesemia", "correct": false}, {"label": "D", "text": "Hypernatremia", "correct": true}], "correct_answer": "D. Hypernatremia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Db6koT5cct1ueukYpDd91740044323.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>One or more of the following: (OR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Two or more of the following:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BMI &lt;16 kg/m<sup>2</sup></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BMI &lt;18.5 kg/m<sup>2</sup></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unintentional weight loss &gt;15% within the last 3-6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unintentional weight loss &gt;10% within the last 3-6 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Little or no nutritional <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> for more than 10 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Little or no nutritional <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> for more than 5 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low potassium, <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> or <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> levels prior to feeding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of alcohol abuse or on medication, including insulin, chemotherapy, antacids or diuretics.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/51c0FXSDU6FJoVQWy3Vi1749042840.mp3", "video": ""}, {"text": "A 30-year-old male undergoes abdominal surgery, and the surgeon plans to use a non-absorbable monofilament suture for skin closure to minimize tissue reaction and ensure long-term wound support. Which of the following sutures should be selected?", "options": [{"label": "A", "text": "Polyglactin 910 (Vicryl)", "correct": false}, {"label": "B", "text": "Polydioxanone (PDS)", "correct": false}, {"label": "C", "text": "Nylon", "correct": true}, {"label": "D", "text": "Polyglycolic acid (Dexon)", "correct": false}], "correct_answer": "C. Nylon", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Hy13eVc1YLjFMDexd9gp1740044364.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monofilament </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polyfilament</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single <span class=\"customMeta\" data-dictid=\"cf25c7ba04169277719946f465928b\">strand</span> of fiber</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple strands braided together</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth &amp; strong</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Easier to handle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased chance of bacterial infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk of infection due to the lodging of bacteria in crevices</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knots tied may become loose (6-8 knots)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knots are stable (3-4 knots)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>E.g.:</p>\n<ul>\n<li>Prolene</li>\n<li>Ethilon</li>\n<li>Nylon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>E.g.:</p>\n<ul>\n<li>Silk</li>\n<li>Linen</li>\n<li>Polyglycolic acid (Dexon)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0njGeYVAPlQBE8rNDDe21749042997.mp3", "video": ""}, {"text": "A 30-year-old man undergoes an open appendectomy, and plain catgut sutures are used for closing the muscle layer. Which of the following statements regarding these sutures is most accurate?", "options": [{"label": "A", "text": "Non-absorbable and provide long-term tensile strength", "correct": false}, {"label": "B", "text": "Made from synthetic materials and are highly resistant to enzymatic degradation", "correct": false}, {"label": "C", "text": "Primarily absorbed by enzymatic proteolysis and has variable tensile strength", "correct": true}, {"label": "D", "text": "Causes minimal tissue reaction and are preferred for patients with suture allergies", "correct": false}], "correct_answer": "C. Primarily absorbed by enzymatic proteolysis and has variable tensile strength", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bLN4y7yhGRRJYfvsWX0j1740044421.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plain Catgut</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromic catgut</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequent uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Superficial vessels ligation</li>\n<li>Subcutaneous tissues suturing Stomas and other tissues that heal rapidly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Same as catgut</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tissues that heal slowly and require prolonged support.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Same as catgut</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tissue reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High (OPTION D ruled out)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absorption rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phagocytosis and <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> within<strong> 7–10 days. </strong>(OPTION C) (Option A ruled out)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phagocytosis and <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> within <strong>90 days.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tensile strength <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> in vivo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lost within <strong>7–10 days</strong></li>\n<li>Marked patient <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> and unpredictable (Option C) (Option A ruled out)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lost within <strong>21–28 days</strong></li>\n<li>Marked patient <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> and unpredictable</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Raw material</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collagen derived from the <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> of sheep small intestine. (OPTION B ruled out)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collagen derived from the <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> of sheep is tanned with <span class=\"customMeta\" data-dictid=\"8b52bb2e7f1692777184b0db8edbb3\">chromium</span> salts to improve handling and resist <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> in tissue.</p>\n<p>Brown in colour</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mOvv3oBSCay4d4WmcjNd1749043237.mp3", "video": ""}, {"text": "A 30-year-old female undergoes an elective laparoscopic cholecystectomy, during which the surgeon uses Vicryl sutures to close the internal fascial layers. Postoperatively, the patient expresses concern about how long the sutures will remain in her body before being fully absorbed. What is the expected time frame for complete absorption of the Vicryl sutures in this case?", "options": [{"label": "A", "text": "60 - 90 days", "correct": true}, {"label": "B", "text": "180 days", "correct": false}, {"label": "C", "text": "90 - 120 days", "correct": false}, {"label": "D", "text": "7 - 10 days", "correct": false}], "correct_answer": "A. 60 - 90 days", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mz626UsQaHYvuXNrn53A1749043362.mp3", "video": ""}, {"text": "A 28-year-old male undergoes repair of a laceration on his forearm following a minor accident. The surgeon chooses monocryl for the subcutaneous layer and polyglycolic acid sutures for the deep dermal layer. Which of the following statements is/are true regarding these sutures in this case? Polyglycaparone is preferred over monocryl for subcuticular suturing Monocryl is a polymer of glycolide and caprolactone Polyglycolic acid exhibits highest affinity for adherence to E.coli and staph. aureus Patient is informed that monocryl will be completely absorbed in 180 days", "options": [{"label": "A", "text": "Only 2", "correct": false}, {"label": "B", "text": "2 and 3", "correct": true}, {"label": "C", "text": "1, 2 and 4", "correct": false}, {"label": "D", "text": "All the statements", "correct": false}], "correct_answer": "B. 2 and 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fQBcrQOYTFAWDNlmXvKz1740044550.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CoXqUHUJcw8438WBmEaE1749043662.mp3", "video": ""}, {"text": "A 45-year-old female undergoes an abdominal hysterectomy. The surgeon chooses to close the rectus sheath using PDS (polydioxanone) sutures due to their prolonged tensile strength. What is the expected time frame for the complete absorption of the polydioxanone sutures in this patient?", "options": [{"label": "A", "text": "60 - 90 days", "correct": false}, {"label": "B", "text": "180 days", "correct": true}, {"label": "C", "text": "90 - 120 days", "correct": false}, {"label": "D", "text": "7 - 10 days", "correct": false}], "correct_answer": "B. 180 days", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FvmKxLEFfXzK1vY5gNGJ1740044590.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Iypj1Fu2shDIjJqJSk461749044200.mp3", "video": ""}, {"text": "A 60-year-old woman with a history of peripheral artery disease presents with critical limb ischemia. She is scheduled for a femoral-popliteal bypass surgery to restore blood flow to her lower extremity. Which suture is preferred for vascular anastomosis?", "options": [{"label": "A", "text": "Prolene", "correct": true}, {"label": "B", "text": "Silk", "correct": false}, {"label": "C", "text": "Vicryl", "correct": false}, {"label": "D", "text": "Nylon", "correct": false}], "correct_answer": "A. Prolene", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zmapvavfOKXZsIND1snx1740044728.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ENjGdzdqIGkMSU6pOZ4H1749044306.mp3", "video": ""}, {"text": "Which of the following best describes Jenkins's rule in the context of abdominal wound closure?", "options": [{"label": "A", "text": "Use of interrupted sutures with bites 2 cm apart to reduce wound tension.", "correct": false}, {"label": "B", "text": "Continuous suturing with bites 1 cm apart, avoiding suture locking to create a \"spring coil\" effect.", "correct": true}, {"label": "C", "text": "Continuous suturing with locking sutures, with bites placed 1 cm from the wound edge", "correct": false}, {"label": "D", "text": "Use of mattress sutures to maximize the tension across the wound during healing", "correct": false}], "correct_answer": "B. Continuous suturing with bites 1 cm apart, avoiding suture locking to create a \"spring coil\" effect.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/EBbNUnTl6cJBDygrJQ6d1749044488.mp3", "video": ""}, {"text": "Which of the following is the recommended knot for securing the final stitch in a continuous suture technique during surgery?", "options": [{"label": "A", "text": "Reef knot", "correct": false}, {"label": "B", "text": "Aberdeen knot", "correct": true}, {"label": "C", "text": "Surgeon’s knot", "correct": false}, {"label": "D", "text": "Buried knot", "correct": false}], "correct_answer": "B. Aberdeen knot", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZxXJGu5TbEn90VRRH1SM1740044910.png", "https://image.prepladder.com/content/6Nf2oTRSo9kCnHZUf0rB1740044938.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suture Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Knot Used</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interrupted Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Individual stitches, each tied off separately.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tied like standard knots.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuous Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single length of <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> for multiple stitches.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aberdeen <span class=\"customMeta\" data-dictid=\"98a26a969a169277719066f5ac85ea\">knot</span> at the end. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mattress Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to <span class=\"customMeta\" data-dictid=\"69dbb476ab16927771872c0d9e30c1\">evert</span> or invert wound edges. Tied like <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> sutures.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tied like standard knots.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subcuticular Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Placed under the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> for a <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> result, using <span class=\"customMeta\" data-dictid=\"330e2bf7d216927771804326d05181\">absorbable</span> sutures if needed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Buried knot.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/U30ctCAzellBiz6JxfBw1749044622.mp3", "video": ""}, {"text": "Which of the following types of surgical needles is most appropriate for suturing tough or dense tissue such as skin and fascia?", "options": [{"label": "A", "text": "Round-bodied needle", "correct": false}, {"label": "B", "text": "Triangular needle", "correct": true}, {"label": "C", "text": "Blunt-ended needle", "correct": false}, {"label": "D", "text": "J-shaped needle", "correct": false}], "correct_answer": "B. Triangular needle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LTns73m09rjSqtpJyB2g1740044986.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shape/Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function/Usage</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Body</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Round-bodied</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Separates tissue fibers, used in intestinal and <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Triangular</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cuts through tough or dense tissue like skin and fascia</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Point</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Round</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tapered end, general use</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conventional Cutting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cutting edge inside curvature</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reversed Cutting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cutting edge outside curvature</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt-ended</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimizes needlestick injuries, used in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall closure</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Half-circle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrointestinal surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>J-shaped</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laparoscopic port site closure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quarter-circle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eye surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compound Curvature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> procedures</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xxGANTa74sp6zQsmr6uV1749044716.mp3", "video": ""}, {"text": "Identify the type of suturing technique used in the image given below.", "options": [{"label": "A", "text": "Interrupted sutures", "correct": true}, {"label": "B", "text": "Continuous sutures", "correct": false}, {"label": "C", "text": "Mattress sutures", "correct": false}, {"label": "D", "text": "Subcuticular sutures", "correct": false}], "correct_answer": "A. Interrupted sutures", "question_images": ["https://image.prepladder.com/content/pXXlRWyEsDFSJkeu1j8w1740045033.png"], "explanation_images": ["https://image.prepladder.com/content/BuPI7EVMkPyUzMOkrPyD1740045151.png", "https://image.prepladder.com/content/FH8hNVp9XNT2nTFxkDhZ1739336708.png", "https://image.prepladder.com/content/qZoEJpywmlEbrHRFkxrj1740045211.png", "https://image.prepladder.com/content/f2b0E1WL2F7rXvFxvzQT1740045268.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:549px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suture Placement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interrupted Sutures</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Olek Remesz\" data-hash=\"\" data-license=\"CC-BY-SA-2.5,2.0,1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Simple_interrupted_suture.svg\" data-tags=\"\" height=\"1070\" src=\"https://image.prepladder.com/content/BuPI7EVMkPyUzMOkrPyD1740045151.png\" width=\"1868\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Needle inserted at 90-degree angle, passed through both sides of wound</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distance = tissue thickness, each <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> twice as far from edge as previous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuous Sutures</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"gynecoloncol\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Continuous_suture.jpg\" data-tags=\"\" height=\"112\" src=\"https://image.prepladder.com/content/FH8hNVp9XNT2nTFxkDhZ1739336708.png\" width=\"154\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous placement after initial start, with <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> appearing diagonal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintain proper tension, secure end with Aberdeen <span class=\"customMeta\" data-dictid=\"98a26a969a169277719066f5ac85ea\">knot</span> or final <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> loop</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mattress Sutures</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/qZoEJpywmlEbrHRFkxrj1740045211.png\" width=\"4168\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertical or horizontal, used to align wound edges</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Passed through both sides, either vertically or horizontally</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subcuticular Sutures</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Olek Remesz\" data-hash=\"\" data-license=\"CC-BY-SA ver. 2.5, 2.0, 1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Subcuticular_suture.svg\" data-tags=\"\" height=\"547\" src=\"https://image.prepladder.com/content/f2b0E1WL2F7rXvFxvzQT1740045268.png\" width=\"705\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aesthetic <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> with small bites of tissue, edges easily approximated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absorbable or non-absorbable, secured with collar and <span class=\"customMeta\" data-dictid=\"b65b938dfa16927771826d42406534\">bead</span> or buried knot</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5sv0Secu7hnL6MVxCYeV1749044828.mp3", "video": ""}, {"text": "A 60-year-old patient is undergoing ileostomy closure and the surgeon opts for a hand-sewn anastomosis technique. Which of the following accurately describes the single-layer hand-sewn anastomosis technique?", "options": [{"label": "A", "text": "It includes an inner continuous suture layer and an outer layer of interrupted sutures.", "correct": false}, {"label": "B", "text": "It uses a continuous suture line through all layers of the bowel wall, except the mucosa.", "correct": true}, {"label": "C", "text": "It uses a continuous suture line through all layers of the bowel wall.", "correct": false}, {"label": "D", "text": "It involves placing a purse-string suture on the distal stump and stapling the anastomosis.", "correct": false}], "correct_answer": "B. It uses a continuous suture line through all layers of the bowel wall, except the mucosa.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/giJ36Tz9ND0nrAj1AeQW1740045328.png", "https://image.prepladder.com/content/TFpe3LvRaFvDihb4i10D1740045356.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Material Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages and Risks</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Single layer Anastomosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line, all layers except mucosa<strong> (Option B) (Option A &amp; C ruled out)</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/giJ36Tz9ND0nrAj1AeQW1740045328.png\" width=\"4167\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monofilament absorbable</p>\n<p>Or</p>\n<p>Vicryl.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quicker procedure</p>\n<p>Potentially lower risk of leakage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Double Layer Anastomosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inner continuous layer <strong>(Albert layer) </strong>+ outer <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> sutures <strong>(Lembert layer)</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/TFpe3LvRaFvDihb4i10D1740045356.png\" width=\"989\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inner layer: Vicryl</p>\n<p>Outer layer: Silk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traditional method with additional support from the outer layer.</p>\n<p><strong>Risk: </strong>Potential for <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> formation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gOkxBEMgyLCpcWKdgoCc1749044972.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Apart from the abdominal cavity, which body part is included in e-FAST?", "options": [{"label": "A", "text": "Pelvic Cavity", "correct": false}, {"label": "B", "text": "Peripheral vessels", "correct": false}, {"label": "C", "text": "Thoracic cavity", "correct": true}, {"label": "D", "text": "Dural and subdural spaces", "correct": false}], "correct_answer": "C. Thoracic cavity", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to GCS, a verbal score of 1 indicates:", "options": [{"label": "A", "text": "No Verbal response", "correct": true}, {"label": "B", "text": "Inappropriate words", "correct": false}, {"label": "C", "text": "Incomprehensible sounds", "correct": false}, {"label": "D", "text": "Oriented response", "correct": false}], "correct_answer": "A. No Verbal response", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Simplified Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale (GCS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5 <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common site of peripheral aneurysm?", "options": [{"label": "A", "text": "Brachial artery", "correct": false}, {"label": "B", "text": "Popliteal artery", "correct": true}, {"label": "C", "text": "Radial artery", "correct": false}, {"label": "D", "text": "Femoral artery", "correct": false}], "correct_answer": "B. Popliteal artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is absent in cases of massive blood transfusion?", "options": [{"label": "A", "text": "DIC", "correct": false}, {"label": "B", "text": "Febrile transfusion reaction", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": true}, {"label": "D", "text": "Thrombocytopenia", "correct": false}], "correct_answer": "C. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications of massive blood transfusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion of cold blood (stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms (coagulopathy), and worsening bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing haemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, thrombocytopenia, and increased risk of continued bleeding.</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DIC</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to the release of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> substances</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leads to haemorrhage due to depleted <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> components, tissue hypoxia, and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> due to microthrombi, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large volumes of transfused blood contain citrate, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypocalcemia leads to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypocalcemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Packed red blood cells (PRBCs) and other blood products are preserved with <strong>citrate</strong>, an anticoagulant.</li>\n<li>Citrate binds to <strong>ionised calcium</strong> (Ca²⁺) in the recipient's blood, reducing the free <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> level - <strong>hypocalcemia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presents as muscle spasms, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, and decreased myocardial contractility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypokalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium may shift intracellularly once transfused red blood cells are metabolically revived.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia causes muscle weakness, paralysis, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased pH (alkalosis) can lead to muscle twitching, irritability, and impaired oxygen release from haemoglobin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leads to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid accumulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowered blood pH (acidosis) leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the recipient's immune response, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Associated Circulatory <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume of transfused blood exceeds the patient’s capacity to manage, leading to fluid overload.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary oedema, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeated transfusions lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron deposits in organs (e.g., liver, heart, pancreas), lead to organ damage and failure over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABO or Rh incompatibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid destruction of red blood cells (hemolysis), causes fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to proteins in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood products are contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sepsis, characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Febrile <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reaction</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a non-hemolytic condition that is not completely understood but is believed to be caused by <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> white blood cells in the blood unit or cytokines that accumulate during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, rigour, chills</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about ranula is FALSE?", "options": [{"label": "A", "text": "Mucus extravasation cyst", "correct": false}, {"label": "B", "text": "Arises from submandibular salivary gland", "correct": true}, {"label": "C", "text": "Bluish, translucent cystic swelling on the floor of the mouth", "correct": false}, {"label": "D", "text": "Marsupialization or excision is the treatment", "correct": false}], "correct_answer": "B. Arises from submandibular salivary gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png", "https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n<p><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Ranulas are a type of <strong>extravasation mucocele</strong>, caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the main <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or obstructed <span class=\"customMeta\" data-dictid=\"4e0948603216927771801829c2c085\">acini</span> of the <strong>sublingual gland</strong>.</li>\n<li>They appear as <strong>bluish, translucent, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> on the floor of the mouth</strong> and resemble the belly of a frog.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ph0t0happy\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ranula_human_09.jpg\" data-tags=\"\" height=\"513\" src=\"https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png\" width=\"573\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Commonly found in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> floor of the mouth.</li>\n<li>When it extends through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle, it presents as a <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> known as a<strong> \"plunging ranula.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Typically soft, fluctuant, and painless unless infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Confirmed through Magnetic Resonance Imaging (MRI)</li>\n<li>Ultrasound</li>\n<li>Aspiration of thick, sticky <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> differentiates it from a lymphangioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is preferred. </strong></li>\n<li>Incision, drainage, and marsupialisation have low success rates. Although <strong>marsupialisation</strong> is often adequate, it has a higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate compared to <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> excision.</li>\n<li>OK-432 injection</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"534\" src=\"https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png\" width=\"534\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who is taking steroids for psoriasis and is experiencing a low-grade fever only at night, weight loss, and an ulcer on her neck with undermined edges, as depicted in the provided image?", "options": [{"label": "A", "text": "Psoriasis flare-up", "correct": false}, {"label": "B", "text": "Tubercular lymphadenitis", "correct": true}, {"label": "C", "text": "Lymphosarcoma", "correct": false}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "B. Tubercular lymphadenitis", "question_images": ["https://image.prepladder.com/notes/1TH1dju86skmeaqbBBxB1747998760.png"], "explanation_images": ["https://image.prepladder.com/content/fEc4u0perN8HZQL6yWkS1747025426.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> TB (Tuberculous Lymphadenitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most common</strong> <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB presentation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV-positive individuals, Immunosuppressive individuals, children, and non-Caucasian women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previously M. bovis; now mainly M. tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Painless </strong>swelling in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, usually <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> (historically called scrofula).</li>\n<li><strong>Early disease: Discrete nodes</strong></li>\n<li>Advanced disease: Matted, nontender mass, possible <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> draining <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">caseous</span> material.</li>\n<li>Pulmonary disease in &lt;50% of cases.</li>\n<li>Systemic symptoms are uncommon except in HIV-positive patients.</li>\n<li>Non-specific reaction → Matting → Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> → Collar stud <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> → Sinus formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (80% yield) or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> biopsy.</strong></li>\n<li>Granulomatous lesions may or may not contain AFBs.</li>\n<li>Cultures are positive in 70–80% of cases.</li>\n<li>HIV-positive patients: Poorly organised or absent granulomas; higher bacterial loads increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infectious diseases</li>\n<li>Lymphomas</li>\n<li>Metastatic carcinomas</li>\n<li>Rare disorders: Kikuchi’s disease, Kimura’s disease, Castleman’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman comes to the OPD with a history of a lump in the left breast. On clinical examination, the size of the lump in the left breast is 9x10 cm with the following appearance and no axillary lymphadenopathy. The histopathology of the biopsy from the lump shows increased stromal cellularity and typical leaflike architecture. What is your likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumour", "correct": true}, {"label": "B", "text": "Giant fibroadenoma", "correct": false}, {"label": "C", "text": "Inflammatory carcinoma", "correct": false}, {"label": "D", "text": "Ductal carcinoma", "correct": false}], "correct_answer": "A. Phyllodes tumour", "question_images": ["https://image.prepladder.com/content/d79JUMsTq9YVRORpAoQE1747116110.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis from the given abdominal x-ray?", "options": [{"label": "A", "text": "Ureterocoele", "correct": false}, {"label": "B", "text": "Pelvic bone fracture", "correct": false}, {"label": "C", "text": "Rectal foreign body", "correct": true}, {"label": "D", "text": "Bladder stone", "correct": false}], "correct_answer": "C. Rectal foreign body", "question_images": ["https://image.prepladder.com/content/MyC6v9qsXI7vAK7gc0TR1748163282.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 52-year-old woman, who underwent a liver transplant 2 months ago, presents with jaundice and bile leakage from the surgical site. Imaging studies suggest narrowing of the bile ducts. What is the most likely complication she is experiencing, and what could be the potential need for management?", "options": [{"label": "A", "text": "Acute cellular rejection- Increase immunosuppressants", "correct": false}, {"label": "B", "text": "Chronic rejection- Continue monitoring", "correct": false}, {"label": "C", "text": "Ischemic-type biliary lesion (ITBL)- Consider retransplantation", "correct": true}, {"label": "D", "text": "Hepatic artery thrombosis- Start anticoagulation therapy", "correct": false}], "correct_answer": "C. Ischemic-type biliary lesion (ITBL)- Consider retransplantation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retransplant Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary Non-function (PNF)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transplanted liver fails to function.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often required.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding due to <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> or coagulopathy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not usually indicated unless severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Thrombosis</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blockage of the <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> artery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often required, especially if early onset.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biliary Complications</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bile leaks, strictures, or ischemic-type <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> lesions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Required in severe cases like ITBLs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">Cellular</span> <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">Rejection</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The immune system attacks the liver.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually managed with medication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic Rejection</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual loss of <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> function over time.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May eventually require retransplant.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IsQCj1BhuJyaAeDd4HG11749113690.mp3", "video": ""}, {"text": "A 55 y/o male with advanced idiopathic pulmonary fibrosis (IPF) is evaluated for lung transplantation. He has significant dyspnea on minimal exertion, and his forced vital capacity (FVC) is 42% of the predicted value. His pre-transplant workup is normal, and he is listed for a single lung transplant. Which of the following conditions is most likely to benefit from single lung transplantation?", "options": [{"label": "A", "text": "Cystic fibrosis", "correct": false}, {"label": "B", "text": "Pulmonary arterial hypertension", "correct": false}, {"label": "C", "text": "Idiopathic pulmonary fibrosis", "correct": true}, {"label": "D", "text": "Bronchiectasis", "correct": false}], "correct_answer": "C. Idiopathic pulmonary fibrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5ByIueEYD3mj2wnrJ8RE1740113113.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of transplant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystic fibrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral and living related (or cadaveric <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> transplants in small highly selected recipients in experienced centers)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interstitial (fibrotic) lung disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral or single (but associated with poorer long-term survival)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emphysema/COPD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral or single (but associated with poorer long-term survival)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral (or rarely combined heart-lung <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> especially if associated with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/36JuwbZ7j8xGE450wbJk1749120360.mp3", "video": ""}, {"text": "A 55 y/o male who underwent heart transplantation 10 years ago presents with exertional dyspnea and fatigue for a few weeks. His initial post-transplant course was uneventful, and he has been compliant with his immunosuppressive regimen. What is the most common cause of late mortality in heart transplant recipients that should be considered in this patient?", "options": [{"label": "A", "text": "Graft rejection", "correct": false}, {"label": "B", "text": "Infection", "correct": false}, {"label": "C", "text": "Cardiac allograft vasculopathy (CAV)", "correct": true}, {"label": "D", "text": "Renal failure", "correct": false}], "correct_answer": "C. Cardiac allograft vasculopathy (CAV)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S.no.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">Graft</span> Dysfunction (PGD)</strong></p>\n<p>(Occurs in about 10% of cases, leading to low <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and <span class=\"customMeta\" data-dictid=\"cd54ecdc411692777183cf0e664818\">biventricular</span> failure.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with</p>\n<ul>\n<li>Ischemia-reperfusion injury</li>\n<li>Older donor/recipient age</li>\n<li>Prolonged ischemic time</li>\n<li>Donor-recipient size mismatch</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur due to</p>\n<ul>\n<li>Prolonged ischemic time.</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance.</li>\n<li>Volume overload.</li>\n<li>Donor size mismatch.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rejection</strong></p>\n<p><strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperacute Rejection: </strong>Rare, due to <span class=\"customMeta\" data-dictid=\"8cb71c753c16927771831c74cb7271\">blood type</span> cross-matching.</p>\n<p><strong>Acute Cellular Rejection: </strong>T-cell mediated, occurring in 20-40% of patients, especially in the first 12 months.</p>\n<p><strong>Antibody-Mediated <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">Rejection</span> (AMR): </strong>Occurs in 10-20% of patients with a mortality rate of 8%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"44d3120c8f16927771815478ab1d1f\">Allograft</span> <span class=\"customMeta\" data-dictid=\"929584f4881692777201f5248a021d\">Vasculopathy</span> (CAV) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Leading cause of late mortality</li>\n<li>Involves <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arterial <span class=\"customMeta\" data-dictid=\"3ccbd45fb116927771904b9e0cd006\">intima</span> thickening.</li>\n<li>Patients often present with <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> due to <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> of the heart, lacking ischemic chest pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infection </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk due to lifelong immunosuppression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunosuppression-related, with higher <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in long-term survivors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Dysfunction </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often due to <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> effects of <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">calcineurin</span> inhibitors used in immunosuppression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetes and Hyperlipidemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resulting from long-term <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> and <span class=\"customMeta\" data-dictid=\"de563cef6b16927771894e23084692\">immunosuppressant</span> use</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7829rYag32hJftHZwJLy1749120158.mp3", "video": ""}, {"text": "A 45-year-old male with end-stage heart failure secondary to ischemic cardiomyopathy is being evaluated for orthotopic heart transplantation. After confirming the indications for transplantation, the surgical team begins the procedure. Which of the following represents the correct sequence of anastomoses typically performed?", "options": [{"label": "A", "text": "Pulmonary artery → Left atrium → Aorta → Right atrium", "correct": false}, {"label": "B", "text": "Left atrium → Right atrium → Pulmonary artery → Aorta", "correct": true}, {"label": "C", "text": "Aorta → Pulmonary artery → Left atrium → Right atrium", "correct": false}, {"label": "D", "text": "Right atrium → Aorta → Pulmonary artery → Left atrium", "correct": false}], "correct_answer": "B. Left atrium → Right atrium → Pulmonary artery → Aorta", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PBrVkD6Ihpzz006ZuZ9A1749120003.mp3", "video": ""}, {"text": "In isolated intestine transplantation, the venous outflow from the allograft is typically established by anastomosis of which of the following?", "options": [{"label": "A", "text": "Donor SMV to the recipient superior vena cava", "correct": false}, {"label": "B", "text": "Donor SMV to the recipient portal vein or inferior vena cava", "correct": true}, {"label": "C", "text": "Donor SMA to the recipient portal vein", "correct": false}, {"label": "D", "text": "Donor SMV to the recipient splenic vein", "correct": false}], "correct_answer": "B. Donor SMV to the recipient portal vein or inferior vena cava", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/88Q5G2nWSDbdwyAtulpT1740112895.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/M9qzxlBzCYaHmWE8SX0j1749119866.mp3", "video": ""}, {"text": "A transplant team is evaluating potential cadaveric donors for a small bowel transplant. Criteria for donor selection include compatible blood type, size of the donor relative to the recipient, and viral serologic testing. Which of the following is NOT a criterion for donor selection in small bowel transplantation?", "options": [{"label": "A", "text": "Blood type compatibility", "correct": false}, {"label": "B", "text": "Donor body weight 50% to 75% of the recipient’s weight", "correct": false}, {"label": "C", "text": "Maximum cold ischemia time of 10 to 12 hours", "correct": true}, {"label": "D", "text": "Donor's minimal vasopressor requirement", "correct": false}], "correct_answer": "C. Maximum cold ischemia time of 10 to 12 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RRp4Ao5QShNrZq3ZeY8Y1749119685.mp3", "video": ""}, {"text": "A 50-year-old female with a history of type 1 diabetes mellitus presents with recurrent severe hypoglycemia with decreased awareness. He is scheduled for islet cell transplantation. Which immunosuppressive regimen is most commonly used to prevent immune rejection of the transplanted islet cells?", "options": [{"label": "A", "text": "Cyclosporine + azathioprine + prednisolone", "correct": false}, {"label": "B", "text": "Methotrexate + mycophenolate mofetil + hydrocortisone", "correct": false}, {"label": "C", "text": "Cyclophosphamide + etanercept + rituximab", "correct": false}, {"label": "D", "text": "Daclizumab + sirolimus + tacrolimus", "correct": true}], "correct_answer": "D. Daclizumab + sirolimus + tacrolimus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jeG5n1IglSyxnqd5AHh61749119471.mp3", "video": ""}, {"text": "A 45-year-old male with a history of type 1 diabetes mellitus undergoes a pancreas transplantation. On postoperative day 3, he develops sudden-onset severe abdominal pain, and doppler ultrasound reveals no blood flow to the pancreas graft. What is the most common cause of pancreatic graft failure in this scenario?", "options": [{"label": "A", "text": "Vascular thrombosis", "correct": true}, {"label": "B", "text": "Anastomotic leak", "correct": false}, {"label": "C", "text": "Pancreatitis", "correct": false}, {"label": "D", "text": "Bleeding", "correct": false}], "correct_answer": "A. Vascular thrombosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZZAceO7jjhnr28fIscsJ1749119329.mp3", "video": ""}, {"text": "Which of the following statements is/are true regarding pancreas transplantation? Type-2 DM with clear c-peptide deficiency is not an indication for pancreas transplantation. End-to-end anastomosis is done between the internal iliac artery and splenic artery Systemic venous drainage is preferred over portal venous drainage Enteric drainage of endocrine secretion is preferred", "options": [{"label": "A", "text": "Only 2", "correct": false}, {"label": "B", "text": "1, 2, and 4", "correct": false}, {"label": "C", "text": "2 and 3", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. 2 and 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BpGcjXKcSMfxhllRp39N1740112733.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3mMEelAXSRdeppTXckUc1749119211.mp3", "video": ""}, {"text": "Which of the following statements is NOT true regarding contraindications and complications of renal transplantation?", "options": [{"label": "A", "text": "Renal vein thrombosis post-surgery is managed conservatively with anticoagulants", "correct": true}, {"label": "B", "text": "Active IV drug abuse is a contraindication for the transplant", "correct": false}, {"label": "C", "text": "Lymphocele can cause ureteric obstruction", "correct": false}, {"label": "D", "text": "Renal artery stenosis post-transplant is best treated by angioplasty", "correct": false}], "correct_answer": "A. Renal vein thrombosis post-surgery is managed conservatively with anticoagulants", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b2KHMZZ0bUAuSAHZkU771749118924.mp3", "video": ""}, {"text": "A 45-year-old male with end-stage renal disease due to polycystic kidney disease is scheduled for a renal transplant, with his brother serving as the donor. During the transplant procedure, where is the donor kidney typically placed, and to which vessel is its renal artery anastomosed?", "options": [{"label": "A", "text": "Right hypochondrium and aorta", "correct": false}, {"label": "B", "text": "Left hypochondrium and external iliac artery", "correct": false}, {"label": "C", "text": "Iliac fossa and Internal iliac artery", "correct": true}, {"label": "D", "text": "Lumbar region and Inferior vena cava", "correct": false}], "correct_answer": "C. Iliac fossa and Internal iliac artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kQmD1wX6p4tBDnDryzwj1740112492.png", "https://image.prepladder.com/content/w4MwMb5EcZkRvbnzYEUJ1740112546.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YmP6lKtvWlYDP9sLQeQT1749118788.mp3", "video": ""}, {"text": "Which of the following parameters is NOT included in the MELD (Model for End-Stage Liver Disease) score?", "options": [{"label": "A", "text": "Bilirubin", "correct": false}, {"label": "B", "text": "Creatinine", "correct": false}, {"label": "C", "text": "International Normalized Ratio (INR)", "correct": false}, {"label": "D", "text": "Albumin", "correct": true}], "correct_answer": "D. Albumin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/EINvPvV0x04BP5EQDpKh1749114102.mp3", "video": ""}, {"text": "A 55-year-old patient with end-stage liver disease receives a liver from a donor with familial amyloid polyneuropathy (FAP) as part of a domino liver transplantation. Which of the following statements is incorrect?", "options": [{"label": "A", "text": "It can use a liver from a patient with familial amyloid polyneuropathy (FAP).", "correct": false}, {"label": "B", "text": "FAP symptoms appear immediately after transplantation.", "correct": true}, {"label": "C", "text": "If the recipient later develops FAP symptoms, they can undergo a retransplantation without risk of malignancy recurrence.", "correct": false}, {"label": "D", "text": "The recipient is less likely to develop or be significantly affected by the metabolic syndrome", "correct": false}], "correct_answer": "B. FAP symptoms appear immediately after transplantation.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CBNFOIonbCfYxupgMe9c1749113876.mp3", "video": ""}, {"text": "Which of the following best describes the definition of a \"deceased person\" according to the Transplantation of Human Organs Act?", "options": [{"label": "A", "text": "A person who has been unconscious for more than 24 hours.", "correct": false}, {"label": "B", "text": "A person who has a permanent cessation of all evidence of life.", "correct": true}, {"label": "C", "text": "A person who has been declared clinically dead but with potential for revival.", "correct": false}, {"label": "D", "text": "A person who has undergone a major surgery with no sign of life for 6 hours.", "correct": false}], "correct_answer": "B. A person who has a permanent cessation of all evidence of life.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:481px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Year</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amendment Focus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2008</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improved framework for deceased organ donation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2011</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Updated to reflect advancements in medical and ethical standards</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/heeBBYB08MH7SIOLrqEk1749109494.mp3", "video": ""}, {"text": "A 40-year-old male with end-stage liver disease due to chronic hepatitis C is being evaluated for a liver transplant. During the evaluation, it was noted that his 38-year-old sister is willing to donate a portion of her liver. Which of the following liver transplant options is most appropriate for this patient?", "options": [{"label": "A", "text": "Deceased Donor Liver Transplantation (DDLT)", "correct": false}, {"label": "B", "text": "Domino Liver Transplantation", "correct": false}, {"label": "C", "text": "Living Donor Liver Transplantation (LDLT)", "correct": true}, {"label": "D", "text": "Split Liver Transplantation", "correct": false}], "correct_answer": "C. Living Donor Liver Transplantation (LDLT)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZaE45nDSZPXDteD8F3sN1749113386.mp3", "video": ""}, {"text": "Which of the following methods is currently considered the gold standard for preserving the pancreas before transplantation?", "options": [{"label": "A", "text": "Hypothermic machine perfusion (HMP)", "correct": false}, {"label": "B", "text": "Normothermic machine perfusion (NMP)", "correct": false}, {"label": "C", "text": "Static cold storage (SCS) with University of Wisconsin (UW) solution", "correct": true}, {"label": "D", "text": "Normothermic regional perfusion (NRP)", "correct": false}], "correct_answer": "C. Static cold storage (SCS) with University of Wisconsin (UW) solution", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages/Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static Cold Storage (SCS) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cooling the organ to 4°C with a preservation solution to reduce metabolism.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The most common method.</li>\n<li>Uses the <strong>University of Wisconsin (UW) solution</strong></li>\n<li>UW solution contains hydroxyethyl <span class=\"customMeta\" data-dictid=\"24511b2ef716927771990798c3d939\">starch</span> (HES), crucial for <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> preservation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothermic Machine <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> (HMP) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuously pumps cooled preservation solution through the organ's vasculature.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Promising in experimental settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normothermic Machine <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> (NMP) </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Circulates warm, oxygenated, red blood cell-based <span class=\"customMeta\" data-dictid=\"c1d9b50e0516927771954b54a8ce2c\">perfusate</span> through the organ.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Creates a <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> environment <em>ex vivo</em>.</li>\n<li>Used in other organs (heart, lung, liver, kidney).</li>\n<li>Less successful for the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to organ injury from high <span class=\"customMeta\" data-dictid=\"d69244457c1692777182592c8395cc\">autolytic</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> concentrations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normothermic Regional <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> (NRP) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Warm, oxygenated blood is pumped back through <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs after <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> arrest.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Beneficial for liver preservation.</li>\n<li>Efficacy for <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> remains inconclusive.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BdJdtrkN84iuPgII3eNb1749113268.mp3", "video": ""}, {"text": "A 45-year-old male is declared legally dead due to irreversible brainstem function loss following a severe head injury. He is considered for organ donation. Which of the following statements is true regarding Donation After Brainstem Death (DBD)?", "options": [{"label": "A", "text": "In DBD complications like graft dysfunction, especially with the liver and pancreas, are expected.", "correct": false}, {"label": "B", "text": "A 5-minute \"no-touch\" period is observed in the case of DBD.", "correct": false}, {"label": "C", "text": "In DBD, organs are perfused with oxygenated blood at the time of procurement.", "correct": true}, {"label": "D", "text": "Warm ischemia is seen in DBD.", "correct": false}], "correct_answer": "C. In DBD, organs are perfused with oxygenated blood at the time of procurement.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DBD (Donation After <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">Brainstem</span> Death)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DCD (Donation After <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">Circulatory</span> Death)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Terminology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart-beating donors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asystolic or Non-heart-beating donors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Legal Death Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irreversible <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> function loss</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irreversible cessation of <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organ Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perfused with oxygenated blood at the time of procurement <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Warm but not perfused with oxygenated blood; risk of warm <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Organ <span class=\"customMeta\" data-dictid=\"cbe99c8c751692777197bc9fcb503b\">retrieval</span> after <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> death declaration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Controlled DCD:</strong> <span class=\"customMeta\" data-dictid=\"cbe99c8c751692777197bc9fcb503b\">Retrieval</span> after a 5-minute \"no-touch\" period post-arrest.<strong>(Option B)</strong></p>\n<p><strong>Uncontrolled DCD</strong>: <span class=\"customMeta\" data-dictid=\"cbe99c8c751692777197bc9fcb503b\">Retrieval</span> following failed <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> in the <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> or ED, with potential <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> recovery after ischemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viability &amp; Outcomes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally good, with organs in better condition due to oxygenation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable quality; higher risk of complications like <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> dysfunction. Outcomes can improve with machine <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> and careful organ selection. <strong>(Option A)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oJFRAgSHU53OJRytcyiY1749113118.mp3", "video": ""}, {"text": "A 52-year-old female who received a multi-visceral transplant presents with unexplained fever, night sweats, and significant weight loss. Her laboratory results show persistent Epstein–Barr virus (EBV) viremia. Which of the following transplant recipients is at the highest risk of developing post-transplant lymphoproliferative disorder (PTLD)?", "options": [{"label": "A", "text": "Kidney transplant recipient", "correct": false}, {"label": "B", "text": "Liver transplant recipient", "correct": false}, {"label": "C", "text": "Intestinal transplant recipient", "correct": true}, {"label": "D", "text": "Heart transplant recipient", "correct": false}], "correct_answer": "C. Intestinal transplant recipient", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 17% of intestinal transplant recipients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High immunosuppression, extensive <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue in grafts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms/Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent EBV viremia, B symptoms (night sweats, fevers, weight loss)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-Line Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rituximab, cautious reduction of <span class=\"customMeta\" data-dictid=\"498d3df3a416927771894f595a597a\">immunosuppression</span> in multi-visceral cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OkSg2iHeazAQnx6nYArB1749112993.mp3", "video": ""}, {"text": "In transplant recipients, which of the following is the most common cause of viral infection within the first 6 months post-transplant?", "options": [{"label": "A", "text": "Herpes Simplex Virus (HSV)", "correct": false}, {"label": "B", "text": "Cytomegalovirus (CMV)", "correct": true}, {"label": "C", "text": "Epstein-Barr Virus (EBV)", "correct": false}, {"label": "D", "text": "BK Virus", "correct": false}], "correct_answer": "B. Cytomegalovirus (CMV)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ICbDjOmO1O2IWi7cr6mc1749112883.mp3", "video": ""}, {"text": "Which intervention has been shown to reduce the risk of graft loss in kidney transplant recipients with BK virus nephropathy?", "options": [{"label": "A", "text": "Increasing the dosage of calcineurin inhibitors", "correct": false}, {"label": "B", "text": "Administering antiviral therapy as a first-line treatment", "correct": false}, {"label": "C", "text": "Timely reduction of immunosuppressive therapy", "correct": true}, {"label": "D", "text": "Routine use of corticosteroids", "correct": false}], "correct_answer": "C. Timely reduction of immunosuppressive therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZcQJLGklBvOjsiLvvevZ1749110058.mp3", "video": ""}, {"text": "Which of the following is the most common malignancy in transplant recipients?", "options": [{"label": "A", "text": "Kaposi Sarcoma", "correct": false}, {"label": "B", "text": "Post-transplant lymphoproliferative Disorder (PTLD)", "correct": false}, {"label": "C", "text": "Squamous Cell Carcinoma", "correct": true}, {"label": "D", "text": "Cytomegalovirus-Associated Tumors", "correct": false}], "correct_answer": "C. Squamous Cell Carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/X8qbIcBDmqdyc4rAOXMx1749109934.mp3", "video": ""}, {"text": "Which of the following drugs works by inhibiting T-cell activation through the blockage of calcineurin, ultimately reducing IL-2 production?", "options": [{"label": "A", "text": "Azathioprine", "correct": false}, {"label": "B", "text": "Prednisone", "correct": false}, {"label": "C", "text": "Tacrolimus", "correct": true}, {"label": "D", "text": "Sirolimus", "correct": false}], "correct_answer": "C. Tacrolimus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Calcineurin Inhibitors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Cyclosporine, Tacrolimus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Inhibit T-cell <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> calcineurin, reducing IL-2 production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Antimetabolites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Azathioprine<strong> (Option A), </strong>Mycophenolate mofetil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"94a2f0970016927771932885a3d362\">nucleotide</span> synthesis, suppressing <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> proliferation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>mTOR Inhibitors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Sirolimus <strong> (Option D)</strong>, Everolimus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Inhibit the mTOR pathway, <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"5173f9c96716927771843cbe0c7611\">cell cycle</span> <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> in T-cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Corticosteroids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Prednisone <strong> (Option B), </strong>Methylprednisolone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Broad anti-inflammatory effects; reduce <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Monoclonal Antibodies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Basiliximab, Rituximab, Belatacept</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Target specific immune cells or cytokines to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> immune responses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Anti-thymocyte <span class=\"customMeta\" data-dictid=\"1a8bcc07ca16927771882f63452d6e\">Globulin</span> (ATG)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Polyclonal antibodies that <span class=\"customMeta\" data-dictid=\"18973785f016927771867c53c72dce\">deplete</span> T-cells, reducing immune response</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/N4z2kP7uGywTajEItc6E1749109848.mp3", "video": ""}, {"text": "Which type of graft involves tissue transplantation between genetically identical individuals, such as identical twins?", "options": [{"label": "A", "text": "Autograft", "correct": false}, {"label": "B", "text": "Allograft", "correct": false}, {"label": "C", "text": "Isograft", "correct": true}, {"label": "D", "text": "Xenograft", "correct": false}], "correct_answer": "C. Isograft", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:545px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Graft Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Autograft</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tissue from one site to another on the same individual</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No risk of immune rejection; high success rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Requires a donor site, additional morbidity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Allograft</p>\n<p><strong>(Option B )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tissue from another individual of the same species</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Availability of larger tissue amounts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Risk of immune rejection; needs immunosuppression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Xenograft</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tissue from a different species (e.g., pig to human)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Readily available; used as temporary grafts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>High risk of immune rejection; often temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Isograft</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tissue between genetically identical individuals</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No risk of immune <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> due to genetic identity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Limited availability; specific to identical twins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/W7DcMgewtP5eV7Qukshx1749109745.mp3", "video": ""}, {"text": "A 45-year-old patient requires a kidney transplant. Which statement about HLA matching is most accurate for this transplant?", "options": [{"label": "A", "text": "Mismatches at the HLA-B locus have a more significant impact on transplant outcomes than mismatches at the HLA-DR locus.", "correct": false}, {"label": "B", "text": "HLA typing is typically performed using DNA sequencing to assess compatibility.", "correct": true}, {"label": "C", "text": "HLA Class I molecules are categorized into HLA-DP, HLA-DQ, and HLA-DR.", "correct": false}, {"label": "D", "text": "Tissue typing in transplantation includes HLA-B, HLA-C, and HLA-DP loci.", "correct": false}], "correct_answer": "B. HLA typing is typically performed using DNA sequencing to assess compatibility.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA Molecules</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class I</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HLA-A, HLA-B, HLA-C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present on most cells, involved in immune response.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HLA-DP, HLA-DQ, HLA-DR</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found on antigen-presenting cells, critical for immune recognition.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fXXlX7YEnU4DAh3VbZlL1747151994.mp3", "video": ""}, {"text": "A 45-year-old male patient undergoes a kidney transplant. Shortly after the procedure, he experiences a rapid onset of graft dysfunction characterized by the destruction of the graft’s vascularization. Which type of rejection does this patient most likely have?", "options": [{"label": "A", "text": "Hyperacute Rejection", "correct": true}, {"label": "B", "text": "Acute Cellular Rejection", "correct": false}, {"label": "C", "text": "Acute Humoral Rejection", "correct": false}, {"label": "D", "text": "Chronic Rejection", "correct": false}], "correct_answer": "A. Hyperacute Rejection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperacute</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minutes to hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibody-mediated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> destruction; pre-existing antibodies; common in kidneys.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute</strong></p>\n<p><strong>(Option B &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cellular &amp; Humoral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cellular (lymphocytes) or <span class=\"customMeta\" data-dictid=\"1a6d065f851692777189ba5533d1ef\">humoral</span> (antibodies) response.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Months to years after <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> rejection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibody- and cell-mediated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrosis and scarring. Specifics:</p>\n<p>Liver: Vanishing <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> syndrome</p>\n<p>Kidney: Chronic <span class=\"customMeta\" data-dictid=\"44d3120c8f16927771815478ab1d1f\">allograft</span> <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> (fibrosis and glomerulopathy)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zYPNAgkRLJxldtJrcLSL1749109640.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A road traffic accident has occurred, and the first response team has arrived at the scene. Which of the following is not a key priority in prehospital care?", "options": [{"label": "A", "text": "Evaluate the scene", "correct": false}, {"label": "B", "text": "Perform an initial assessment", "correct": false}, {"label": "C", "text": "Make triage-transport decision", "correct": false}, {"label": "D", "text": "Transport immediately and delay interventions", "correct": true}], "correct_answer": "D. Transport immediately and delay interventions", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mDGvMXtCMnQmCQZANQTO1747230914.mp3", "video": ""}, {"text": "After a high-speed road traffic accident, a trauma team arrives to find multiple critically injured patients. According to the trimodal mortality model, which statement is correct?", "options": [{"label": "A", "text": "Immediate deaths occur days after the injury", "correct": false}, {"label": "B", "text": "Early deaths occur within hours of reaching the hospital", "correct": true}, {"label": "C", "text": "Majority of deaths are due to cardiac causes", "correct": false}, {"label": "D", "text": "Late deaths are mostly due to internal hemorrhage", "correct": false}], "correct_answer": "B. Early deaths occur within hours of reaching the hospital", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late death</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>This peak occurs seconds to minutes after the injury. (Option A) </strong></li>\n<li>Due to the extreme nature of these injuries, very few patients in this category can be saved, and prevention remains the most effective way to address this peak.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>This peak occurs within minutes to several hours post-injury.</strong></li>\n<li>The \"golden hour\" of trauma care, characterized by a need for rapid assessment and resuscitation, is crucial in managing these patients.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>This peak emerges days to weeks after the initial injury.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe and nonsurvivable injury</li>\n<li>Irreversible brain injury</li>\n<li>Hemorrhages of organs like:</li>\n<li>Heart</li>\n<li>Aorta</li>\n<li>Liver</li>\n<li>Lungs</li>\n<li>Pelvic fracture</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intracranial hemorrhage/ brain lacerations/ contusions</li>\n<li>Hemorrhage of <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs.</li>\n<li>Multiple small injuries causing major blood loss.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infection/sepsis or Multiorgan failure (MODS) (80% cases) <strong>(Option D)</strong></li>\n<li>Brain injury</li>\n<li>Hemorrhage</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4BNnYM6vEJBYRYC47wfw1747154916.mp3", "video": ""}, {"text": "After a major earthquake, a patient presents with a compound fracture and spinal injuries. Considering the severity of these injuries and the urgency of treatment, which triage color code is most appropriate for this patient?", "options": [{"label": "A", "text": "Black", "correct": false}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Green", "correct": false}, {"label": "D", "text": "Yellow", "correct": true}], "correct_answer": "D. Yellow", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Priority </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Need </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Status </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red (Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Critical, but likely to survive if treatment given early</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> trauma</li>\n<li>Tension pneumothorax</li>\n<li>Profuse external bleeding</li>\n<li>Haemothorax</li>\n<li>Flail chest</li>\n<li>Major <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> bleed</li>\n<li>Extradural haematomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Second</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Critical, but likely to survive if treatment given within hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Compound fractures</li>\n<li>Degloving injuries</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscus</li>\n<li>Pelvic fracture</li>\n<li>Spinal injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Green (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Third</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stable, likely to survive even if treatment is delayed for hours to days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Simple fractures</li>\n<li>Sprains</li>\n<li>Minor lacerations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Last</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unsalvageable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not breathing, pulseless, so severely injured that no medical care is likely to help</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe brain damage</li>\n<li>Very extensive burns</li>\n<li>Major disruption/ loss of chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall structures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZTrMCMFCHo5MzQfMdG1v1747231143.mp3", "video": ""}, {"text": "In an emergency situation in the casualty, the ATLS protocol is followed after a patient who was in a road traffic accident is brought to the hospital. Which of the following is not a component in the primary evaluation of the patient?", "options": [{"label": "A", "text": "Detailed history of the patient", "correct": true}, {"label": "B", "text": "Airway assessment", "correct": false}, {"label": "C", "text": "Rule out shock", "correct": false}, {"label": "D", "text": "Check for neurological disability", "correct": false}], "correct_answer": "A. Detailed history of the patient", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KrdNWPMoEOWgkh8pnlK71740027233.png", "https://image.prepladder.com/content/8VU8rNGxwLqznc5lGEGz1740027299.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bDuGOivKIenqR202OvNd1747231272.mp3", "video": ""}, {"text": "A 34-year-old patient arrives at the emergency department after a motor vehicle collision. The ED physician is assessing whether to order spinal imaging. Which of the following findings does not indicate that spinal imaging is necessary?", "options": [{"label": "A", "text": "No focal neurological deficit", "correct": true}, {"label": "B", "text": "Patient is intoxicated", "correct": false}, {"label": "C", "text": "Altered level of consciousness", "correct": false}, {"label": "D", "text": "Presence of midline spinal tenderness", "correct": false}], "correct_answer": "A. No focal neurological deficit", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aRLtLOySgRZjEtAf23Ax1740027346.png", "https://image.prepladder.com/content/MxfyEW9fHrr2tHzZPrhx1740027406.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BUuvcmONyK1UVbHMBszi1747231458.mp3", "video": ""}, {"text": "A critically injured patient is brought to the emergency department. The primary assessment is started. In the following algorithm identify the missing step (a) and action (b).", "options": [{"label": "A", "text": "a- Assess airway, b- Establish stable airway", "correct": true}, {"label": "B", "text": "a- Assess circulation, b- Prevent shock", "correct": false}, {"label": "C", "text": "a- Establish airway, b- Assess circulation", "correct": false}, {"label": "D", "text": "a- Assess airway, b- Assess circulation", "correct": false}], "correct_answer": "A. a- Assess airway, b- Establish stable airway", "question_images": ["https://image.prepladder.com/content/kHJXtiA0XLXbpHMeTJs51740027444.png"], "explanation_images": ["https://image.prepladder.com/content/rAOVENH8QM9fC48Fnin81740027467.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fdBHOykDR8m8B2v57SYg1747231618.mp3", "video": ""}, {"text": "A road accident patient, stabilized with no severe external injuries, suddenly develops tachycardia, weak pulses, hypotension, and tachypnoea. Which ATLS primary assessment component is most likely causing these symptoms?", "options": [{"label": "A", "text": "Airway", "correct": false}, {"label": "B", "text": "Circulation", "correct": true}, {"label": "C", "text": "Neurological", "correct": false}, {"label": "D", "text": "Hypothermia", "correct": false}], "correct_answer": "B. Circulation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/If7DoHrbZhMwo492Jp2O1747231792.mp3", "video": ""}, {"text": "A 35-year-old male is brought in after a fall from height and is found to be in hypovolemic shock. According to ATLS protocol, which of the following investigations is not recommended during the primary survey to identify the cause of the life-threatening bleed?", "options": [{"label": "A", "text": "FAST scan", "correct": false}, {"label": "B", "text": "Chest X-Ray", "correct": false}, {"label": "C", "text": "Pelvic radiograph", "correct": false}, {"label": "D", "text": "CT scan", "correct": true}], "correct_answer": "D. CT scan", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Keq3qpocMogEShzzyUtb1747231927.mp3", "video": ""}, {"text": "Which of the following statements is true regarding the CRASH-2 trial in trauma? (TXA= Tranexamic acid)", "options": [{"label": "A", "text": "TXA is more effective when given after 3 hours of trauma.", "correct": false}, {"label": "B", "text": "TXA reduced all-cause mortality versus placebo.", "correct": true}, {"label": "C", "text": "TXA in children worsens pulmonary and neurological outcomes.", "correct": false}, {"label": "D", "text": "CRASH-2 showed TXA is ineffective in trauma.", "correct": false}], "correct_answer": "B. TXA reduced all-cause mortality versus placebo.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PGDZFfEiDXJVAXmCWHbG1747232200.mp3", "video": ""}, {"text": "During the primary survey of a trauma patient in the emergency department, which of the following injuries is not classified as life-threatening under the category of “breathing” problems?", "options": [{"label": "A", "text": "Flail chest", "correct": false}, {"label": "B", "text": "Hemothorax", "correct": false}, {"label": "C", "text": "Bronchial rupture", "correct": false}, {"label": "D", "text": "Expanding hematoma", "correct": true}], "correct_answer": "D. Expanding hematoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1bzj3Mz18yv0qh1GqffT1747232438.mp3", "video": ""}, {"text": "A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "5", "correct": false}, {"label": "B", "text": "6", "correct": true}, {"label": "C", "text": "7", "correct": false}, {"label": "D", "text": "8", "correct": false}], "correct_answer": "B. 6", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pupil <span class=\"customMeta\" data-dictid=\"d4b70f945316927771972d75389cf0\">Reactivity</span> Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KdqwuoAXFuPsZSKWGhRG1747232562.mp3", "video": ""}, {"text": "A 25-year-old male involved in a high-speed motor vehicle accident is brought to the emergency department. After completing the primary survey and stabilizing the patient, the trauma team begins the secondary survey. Which of the following steps is not a part of the secondary survey?", "options": [{"label": "A", "text": "Identifying external hemorrhage", "correct": true}, {"label": "B", "text": "Full neurological examination", "correct": false}, {"label": "C", "text": "Thorough head-to-toe examination", "correct": false}, {"label": "D", "text": "Obtaining a detailed patient history", "correct": false}], "correct_answer": "A. Identifying external hemorrhage", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:0px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Survey: </strong> Focuses on immediate life-saving interventions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Survey: </strong> Conducted after the patient is stabilized.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Airway with <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine protection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete head-to-toe physical examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breathing and ventilation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Full neurological examination (e.g., GCS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Circulation with <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> control</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History taking using the AMPLE mnemonic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disability (neurological status)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Examination for fractures, soft tissue injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exposure and environmental control (e.g., prevent hypothermia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detailed examination of all systems</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ERDtphfCGGFzSnwETasU1747232709.mp3", "video": ""}, {"text": "A 30-year-old woman with mid-facial trauma from a car accident is stabilized and the secondary survey begins. Which of the following is not an appropriate step in the secondary survey?", "options": [{"label": "A", "text": "Obtaining a detailed history", "correct": false}, {"label": "B", "text": "Digital rectal examination for spinal injury", "correct": false}, {"label": "C", "text": "Nasogastric tube in a patient with mid-facial fractures", "correct": true}, {"label": "D", "text": "Repeat FAST examination for abdominal injury", "correct": false}], "correct_answer": "C. Nasogastric tube in a patient with mid-facial fractures", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prerequisites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary survey must be completed.</li>\n<li>Resuscitation initiated.</li>\n<li>All life-threatening conditions identified and addressed.</li>\n<li>Normalization of vital signs should have begun.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obtain AMPLE History</strong><strong> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A focused history covering: <strong>A</strong>llergies, <strong>M</strong>edications, <strong>P</strong>revious medical history/illness or Pregnancy, <strong>L</strong>ast meal, <strong>E</strong>vents/environment related to the injury. This guides ongoing care and anticipates complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systematic head-to-toe exam including front, back, sides, and hidden areas (scalp, axillae, perineum).</li>\n<li>Reassess <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> and lung function.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vital Signs Assessment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monitor vital signs regularly.</li>\n<li>Narrow <span class=\"customMeta\" data-dictid=\"2181cd88c916927771965490f0a73c\">pulse pressure</span> and <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> suggest hypovolemic shock.</li>\n<li>Be cautious with delayed <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> changes in the elderly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Head and Face Examination</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check for <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> hematomas, skull depression, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> fractures, septal hematomas, raccoon eyes, or Battle’s sign.</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> if <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> trauma is present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neck Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immobilize and <span class=\"customMeta\" data-dictid=\"5aabcb1ee8169277719447f2dd6c2c\">palpate</span> the neck.</li>\n<li>Rule out <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine injury with <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or clinical criteria..</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palpate for tenderness, crepitus, and fractures.</li>\n<li>Inspect for seatbelt bruising and assess <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> and heart sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdomen Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Look for distension, bruising, tenderness, and marks.</li>\n<li>Assess for peritoneal injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pelvic and Rectal Examination </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> and <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> injury.</li>\n<li>Perform digital rectal exam if there is suspicion of rectal or urethral injury, especially in <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord injury, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures or gunshot wounds to the pelvis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genital Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vaginal examination in women with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures or lacerations.</li>\n<li>Assess for signs of <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> trauma or pregnancy-related complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extremities Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluate for fractures, tenderness, deformities, <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> status, and signs of <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reassess Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale</li>\n<li>Evaluate <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> and motor functions, pupillary response, and signs of head injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FAST </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use Focused <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> <span class=\"customMeta\" data-dictid=\"2f728bd574169277719835f6456848\">Sonography</span> for Trauma (FAST) to check for internal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> injury or unexplained blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Special Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Update <span class=\"customMeta\" data-dictid=\"64dfe4fca51692777200a7ffbc44bb\">tetanus</span> status.</li>\n<li>Assess <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output.</li>\n<li>Remove dressings to reassess injuries.</li>\n<li>Remove <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> collar briefly to evaluate the neck while maintaining immobilization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests and Consultations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obtain additional <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab tests as needed and request specialist consultations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tertiary Survey</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conducted within 24 hours for multisystem trauma patients to identify missed injuries from primary and secondary surveys.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1wQBlajYtRzCc0Lof7CS1747232850.mp3", "video": ""}, {"text": "A 35-year-old male arrives in the emergency department after a motor vehicle collision with unstable vitals and multiple injuries. Which trauma severity score is most appropriate for predicting his likelihood of survival?", "options": [{"label": "A", "text": "Injury Severity Score (ISS)", "correct": false}, {"label": "B", "text": "Revised Trauma Score (RTS)", "correct": false}, {"label": "C", "text": "Trauma and Injury Severity Score (TRISS)", "correct": true}, {"label": "D", "text": "Mangled Extremity Severity Score (MESS)", "correct": false}], "correct_answer": "C. Trauma and Injury Severity Score (TRISS)", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:526px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Application</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ISS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anatomical injury in body regions (AIS system)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures overall injury severity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Rate, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physiological response to trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TRISS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination of ISS, RTS, and Age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predicts survival <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> in trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MESS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limb ischemia, shock, age, and energy of injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predicts need for <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">amputation</span> in limb trauma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/l2omOdB7mJMzZvKnRQor1747233145.mp3", "video": ""}, {"text": "A 40-year-old male is admitted to the hospital after a major traumatic injury. On the third day post-trauma, his oxygen consumption and metabolic rate have increased significantly, and he exhibits elevated catecholamine levels. Which phase of the metabolic response is this patient most likely in?", "options": [{"label": "A", "text": "Ebb phase", "correct": false}, {"label": "B", "text": "Flow phase", "correct": true}, {"label": "C", "text": "Anabolic phase", "correct": false}, {"label": "D", "text": "Recovery phase", "correct": false}], "correct_answer": "B. Flow phase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ebb Phase (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First 24–48 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↓ <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> rate,</li>\n<li>↓ Energy expenditure,</li>\n<li>↓ <span class=\"customMeta\" data-dictid=\"391d32291016927771932bab695579\">Nitrogen</span> excretion, <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">Hemodynamic</span> stability</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow Phase </strong><strong>or Catabolic phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2–7 days post-trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↑ <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> rate,</li>\n<li>↑ Oxygen consumption, Catabolism,</li>\n<li>↑ Catecholamines</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anabolic Phase (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weeks post-trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"391d32291016927771932bab695579\">nitrogen</span> balance,</li>\n<li>Protein synthesis,</li>\n<li>Restoration of tissue mass</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/liLUfS2RWBGRf4l1fB9k1747233304.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "All of the following are true about small bowel duplication except?", "options": [{"label": "A", "text": "These are submucosa-lined structures in continuity with the GI tract", "correct": true}, {"label": "B", "text": "The most common site is the ileum", "correct": false}, {"label": "C", "text": "Cystic duplication is the most common type", "correct": false}, {"label": "D", "text": "Located along the mesenteric border", "correct": false}], "correct_answer": "A. These are submucosa-lined structures in continuity with the GI tract", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d34uGoGUGBSNPiOIszJj1740042831.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cystic duplication: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tubular duplication:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common - 75% cases <strong>(Option C)</strong></li>\n<li>It does not communicate with the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of the small intestine</li>\n<li>Partial small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> leads to:\n\t\t\t\t<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Vomiting</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>25% cases</li>\n<li>Communicates with the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of the small intestine\n\t\t\t\t<ul>\n<li>If the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> part communicates: <strong>Proximal duplication</strong>.</li>\n<li>If the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> part communicates: <strong>Distal duplication</strong>.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (ileal ulcer) → acid production → <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> → <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> → hematochezia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Eb877ONrQk9U0yEqrYFg1749125458.mp3", "video": ""}, {"text": "A 10-day-old female baby was brought to the OPD with the following findings as shown in the image given below. On examination there is no cough impulse in the swelling. X-ray examination shows the erosion of the coccyx. The most likely clinical diagnosis would be:", "options": [{"label": "A", "text": "Spina bifida", "correct": false}, {"label": "B", "text": "Myelomeningocele", "correct": false}, {"label": "C", "text": "Sacrococcygeal teratoma", "correct": true}, {"label": "D", "text": "Sacral agenesis", "correct": false}], "correct_answer": "C. Sacrococcygeal teratoma", "question_images": ["https://image.prepladder.com/content/cxVgSPCg9CuLmURQ2LJn1740043232.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vKuW7R6w0fyW7icI171Q1749127669.mp3", "video": ""}, {"text": "How will you manage a case of anorectal malformation with no visible fistula in a female patient with cross-table lateral X-ray showing rectum below the coccyx?", "options": [{"label": "A", "text": "Protective colostomy followed by posterior sagittal anorectoplasty", "correct": true}, {"label": "B", "text": "Anoplasty", "correct": false}, {"label": "C", "text": "Colostomy", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Protective colostomy followed by posterior sagittal anorectoplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wgJiwFjUYBpjXPxtyMEL1740043183.png", "https://image.prepladder.com/content/dkDIZHmzFA5xSbwXe0Et1739334827.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8VREtdfO0RCJOJaIDJsF1749127557.mp3", "video": ""}, {"text": "Which of the following diagnostic methods is used to differentiate between a high and low lesion in anorectal malformation, and how does it determine the location of the rectum?", "options": [{"label": "A", "text": "Abdominal ultrasound; identifies the rectal location by imaging the entire pelvic cavity.", "correct": false}, {"label": "B", "text": "MRI of the pelvis; differentiates based on the presence of anatomical anomalies in the pelvic floor", "correct": false}, {"label": "C", "text": "Invertogram; assesses the rectal termination by the rise of gas in relation to the pelvic floor.", "correct": true}, {"label": "D", "text": "X-ray of the pelvis; determines rectal termination based on bone structures and distance from the pelvic floor.", "correct": false}], "correct_answer": "C. Invertogram; assesses the rectal termination by the rise of gas in relation to the pelvic floor.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QlpadAqHu2kfcwLNmRro1740043129.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/T3wFoC6I9zZWzZJ2MRKa1749127279.mp3", "video": ""}, {"text": "Which of the following accurately describes a component and a step involved in the LADD's operation for managing intestinal malrotation?", "options": [{"label": "A", "text": "Appendectomy; Division of LADD’s bands near the medial aspect of the duodenum", "correct": false}, {"label": "B", "text": "Reduction of volvulus; Widening of the mesenteric base by mobilizing the duodenum", "correct": true}, {"label": "C", "text": "Bowel repositioning; Resection of viable bowel wrapped in warm, moist sponges", "correct": false}, {"label": "D", "text": "Division of LADD’s bands; Placement of the duodenum and proximal jejunum on the left side of the abdomen", "correct": false}], "correct_answer": "B. Reduction of volvulus; Widening of the mesenteric base by mobilizing the duodenum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nskDAXqglMjyi4Y2FToB1740043062.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Qdsz41gDhQFVKZFbfaRx1749127090.mp3", "video": ""}, {"text": "A 3-week-old infant presents with sudden-onset bilious vomiting and lethargy. The baby has been experiencing intermittent abdominal pain and has not been gaining weight as expected. On examination, the infant shows signs of poor perfusion and decreased urine output. Which of the following is the most likely diagnosis, and what should be the primary investigation to confirm it?", "options": [{"label": "A", "text": "Intestinal Malrotation with Midgut Volvulus; Upper GI Contrast Study", "correct": true}, {"label": "B", "text": "Pyloric Stenosis; Upper GI Contrast Study", "correct": false}, {"label": "C", "text": "Intestinal Malrotation with Midgut Volvulus; Barium Swallow Study", "correct": false}, {"label": "D", "text": "Pyloric Stenosis; Barium Swallow Study", "correct": false}], "correct_answer": "A. Intestinal Malrotation with Midgut Volvulus; Upper GI Contrast Study", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vcIOTPa1UPCd6iwZdrF01749126925.mp3", "video": ""}, {"text": "Which of the following statements is true about hyper-rotation of intestines?", "options": [{"label": "A", "text": "The cecum is located in the left hypochondrium", "correct": true}, {"label": "B", "text": "The cecum is in the midline inferior to the pylorus", "correct": false}, {"label": "C", "text": "Arrested counter-clockwise rotation around 180°", "correct": false}, {"label": "D", "text": "The presence of Ladd's bands is noticed", "correct": false}], "correct_answer": "A. The cecum is located in the left hypochondrium", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Abnormalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common rotational abnormality.</li>\n<li>Failure of counter-clockwise <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> after return of <span class=\"customMeta\" data-dictid=\"8251cf3ec316927771925d519dd348\">midgut</span> to the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duodenum (C-loop), <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">Ligament</span> of Treitz, and small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> are on the right side.</li>\n<li>Cecum and large <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> are on the left side.</li>\n<li>Proximal <span class=\"customMeta\" data-dictid=\"4b145c8d1b1692777190177246177d\">jejunum</span> and <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> fused as one pedicle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incomplete Rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common type of malrotation.</li>\n<li>Arrested counter-clockwise <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> around 180° <strong>(Option C)</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> lies on the right side.</li>\n<li>DJ <span class=\"customMeta\" data-dictid=\"13e47cfa68169277720299cd54beb4\">flexure</span> located on the right side of the vertebral column.</li>\n<li>Duodenum may have a corkscrew configuration.</li>\n<li>Major part of the large <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> on the left side.</li>\n<li>Cecum is close to midline.</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> located more medially.</li>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> in right hypochondrium, leading to narrow intestinal <span class=\"customMeta\" data-dictid=\"9f51fc9a741692777192ec164a061f\">mesentery</span> and presence of Ladd's bands. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reverse Rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rotation occurs in a clockwise direction around the SMA.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duodenum is <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the superior mesenteric artery.</li>\n<li>Transverse <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> is <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the superior mesenteric artery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyper-Rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Counter-clockwise <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> greater than 270°.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cecum is located in the left <span class=\"customMeta\" data-dictid=\"c8bf2605091692777189746f65e812\">hypochondrium</span> <strong>(Option A)</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mixed Rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intestine does not <span class=\"customMeta\" data-dictid=\"ed17327223169277719753b0e5d6b4\">rotate</span> as it enters the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> after a <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> hernia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cecum is located in the midline, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to the <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> <strong>(Option B)</strong>.</li>\n<li>Increased risk of volvulus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AmBLCrBTCTdWy6f70OID1749126734.mp3", "video": ""}, {"text": "A 3-day-old male baby is brought with complaints of irritable crying. Mother gave the history of not passing meconium in the first 48 hours of life. On examination, abdominal distension was seen with rebound tenderness and reduced bowel sounds. Identify the condition.", "options": [{"label": "A", "text": "Complicated meconium ileus", "correct": true}, {"label": "B", "text": "Sigmoid volvulus", "correct": false}, {"label": "C", "text": "Duodenal atresia", "correct": false}, {"label": "D", "text": "Midgut volvulus", "correct": false}], "correct_answer": "A. Complicated meconium ileus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/V2PKdsuaigAQWadJIZjv1740042996.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4jsH3G2Mx3Lul46CktZF1749126464.mp3", "video": ""}, {"text": "At 2 days of life, a male newborn becomes irritable and inconsolable. He is noted to have abdominal distension. He failed to pass meconium since being born. A follow-up barium enema shows microcolon and terminal ileum with meconium. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Sigmoid volvulus", "correct": false}, {"label": "B", "text": "Hirschsprung disease", "correct": false}, {"label": "C", "text": "Duodenal atresia", "correct": false}, {"label": "D", "text": "Meconium ileus", "correct": true}], "correct_answer": "D. Meconium ileus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/k3fnlKt19UkM9JxP0NE31740042894.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/P2fravXV0fdidis5g0hR1749126290.mp3", "video": ""}, {"text": "Which of the following statements about the meconium plug are false?", "options": [{"label": "A", "text": "Associated with hypothyroidism and cystic fibrosis", "correct": false}, {"label": "B", "text": "X-ray of the abdomen shows the corkscrew's appearance", "correct": true}, {"label": "C", "text": "Water-soluble contrast enema is used for diagnosis and therapeutic purposes.", "correct": false}, {"label": "D", "text": "It is mostly seen in preterm infants.", "correct": false}], "correct_answer": "B. X-ray of the abdomen shows the corkscrew's appearance", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kArLr2Ys9vWpLt1XpMZ81749126147.mp3", "video": ""}, {"text": "A 35-year-old man presents with recurrent chest infections and dyspnea. Chest CT reveals a 5 cm, well-defined, fluid-filled cystic lesion in the right paratracheal region. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary sequestration", "correct": false}, {"label": "B", "text": "Bronchogenic cyst", "correct": true}, {"label": "C", "text": "Pericardial cyst", "correct": false}, {"label": "D", "text": "Hydatid cyst", "correct": false}], "correct_answer": "B. Bronchogenic cyst", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/glKD54C40BCi76gCZEEt1740042369.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GRLT6yCDaANijyA38v1a1749121626.mp3", "video": ""}, {"text": "A 3-day-old neonate presents with abdominal distension and bilious vomiting. An erect X-ray of the abdomen is done, as shown below. What is the most probable diagnosis you suspect?", "options": [{"label": "A", "text": "Jejunoileal atresia", "correct": true}, {"label": "B", "text": "Congenital diaphragmatic hernia", "correct": false}, {"label": "C", "text": "Sigmoid volvulus", "correct": false}, {"label": "D", "text": "Duodenal atresia", "correct": false}], "correct_answer": "A. Jejunoileal atresia", "question_images": ["https://image.prepladder.com/content/Blg9sXQO3iuNRijwGxyi1740042751.png"], "explanation_images": ["https://image.prepladder.com/content/2l859UDyx0KUheceJBDZ1740042782.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Membranous <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with intact <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> mesentery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">With an <span class=\"customMeta\" data-dictid=\"ea0576691016927771821e34e1a7e7\">atretic</span> cord between two blind ends of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> with intact mesentery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Complete separation of the blind ends of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> by a V-shaped mesenteric gap</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 3b </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">An apple peel or <span class=\"customMeta\" data-dictid=\"b8333b75e01692777184815d6f8335\">Christmas tree deformity</span> with a large mesenteric gap</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Multiple atresias, with a string of sausage appearance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SyrijyhMIsVTwIGFX12y1749125334.mp3", "video": ""}, {"text": "On observing the following finding in the X-ray of a baby with a history of Down’s syndrome, what is the most likely diagnosis you would suspect?", "options": [{"label": "A", "text": "Duodenal atresia", "correct": true}, {"label": "B", "text": "Ileal atresia", "correct": false}, {"label": "C", "text": "Jejunal atresia", "correct": false}, {"label": "D", "text": "Congenital hypertrophic pyloric stenosis", "correct": false}], "correct_answer": "A. Duodenal atresia", "question_images": ["https://image.prepladder.com/content/nLcBWKOXcU0061WgF2ho1740042639.png"], "explanation_images": ["https://image.prepladder.com/content/kKPIMYoQK7nfnU8cQTjY1740042679.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VvLUdlPyDXx4YSUTPwR61749125219.mp3", "video": ""}, {"text": "An 8-week-old infant is diagnosed with type 3 biliary atresia. The surgical team is planning the most appropriate intervention for this patient. Which of the following describes the preferred surgical approach for this patient?", "options": [{"label": "A", "text": "Liver transplantation", "correct": false}, {"label": "B", "text": "Kasai porto-enterostomy", "correct": true}, {"label": "C", "text": "Choledochoenterostomy", "correct": false}, {"label": "D", "text": "Conservative management with ursodeoxycholic acid", "correct": false}], "correct_answer": "B. Kasai porto-enterostomy", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exploratory laparotomy</li>\n<li>Intra-operative Cholecysto-cholangiogram\n\t\t\t\t<ul>\n<li>To confirm the diagnosis,</li>\n<li>Demonstrate fibrotic <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> remnant</li>\n<li>Define absent <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> &amp; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> patency</li>\n</ul>\n</li>\n<li><strong>For Type 1-</strong> Roux-en-Y jejunal anastomosis</li>\n<li><strong>For <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> and above-</strong> Kasai Porto-enterostomy (TOC)</li>\n<li>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> may be required after 3 months.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Kasai portoenterostomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Removal of <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> and <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> in case of progressive obliteration</li>\n<li>Division of jejunum, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> part taken, and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> part anastomosed into the side of the jejunum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Postoperative drug therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>UDCA (Facilitates <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow)</li>\n<li>Methylprednisolone (anti-inflammatory agent)</li>\n<li>TMP-SMX (For <span class=\"customMeta\" data-dictid=\"78d28b340916927771810a3fffeb0a\">antimicrobial</span> prophylaxis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Postoperative Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common:</strong> Cholangitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No medical treatment can reverse the process of <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> atresia</li>\n<li>If Surgery is not performed, death occurs within 2 years</li>\n<li>Surgery should be done <strong>within 60 days of birth</strong> for better outcomes and survival</li>\n<li>30% of patients undergoing <span class=\"customMeta\" data-dictid=\"ef372e1a77169277719617089e30bf\">Portoenterostomy</span> before 60 days of age have long-term successful survival &amp; <strong>don't require liver transplantation</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kVHt9JPgrWKIuEDXNUui1749124508.mp3", "video": ""}, {"text": "A 3-week-old infant is brought to the pediatrician with persistent jaundice and pale, clay-colored stools. The parents report that the baby is not gaining weight as expected. On physical examination, the infant appears jaundiced and the liver is palpable 2 cm below the right costal margin. Which of the following diagnostic tests would be most specific for confirming the suspected diagnosis?", "options": [{"label": "A", "text": "Abdominal ultrasound", "correct": false}, {"label": "B", "text": "CECT", "correct": false}, {"label": "C", "text": "Hepatobiliary scintigraphy", "correct": false}, {"label": "D", "text": "Intraoperative cholangiogram", "correct": true}], "correct_answer": "D. Intraoperative cholangiogram", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstructive <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">Jaundice</span> at birth or some days after birth</li>\n<li>Passage of <strong>acholic pale grey stools </strong>(due to obstructed <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow)</li>\n<li>Failure to thrive</li>\n<li>Signs and symptoms of <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> &amp; <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure (if diagnosis or treatment is delayed)</li>\n<li>In 25% of cases - Associated malformations (Polysplenia, Malrotation, Preduodenal <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> Vein, Intrahepatic <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathological Hallmarks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> proliferation</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"77786ce4911692777184f875836332\">cholestasis</span> with plugging</li>\n<li>Inflammatory cell infiltrate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gold standard:</strong> Intraoperative/perioperative <span class=\"customMeta\" data-dictid=\"1ce0e2753d1692777184bce481749e\">cholangiogram</span> / <span class=\"customMeta\" data-dictid=\"c3fef8e95a169277718470e72e79f2\">cholecystocholangiogram</span> <strong>(Option D)</strong></li>\n<li><strong>USG Findings:</strong> Gallbladder is shrunken, CBD is not visible <strong>(Option A)</strong></li>\n<li><strong>USG Signs:</strong> Gallbladder Ghost triad, triangular cord sign</li>\n<li><strong>Hepatobiliary scintigraphy:</strong> Uptake into the liver without any flow into the duodenum/excretion of <span class=\"customMeta\" data-dictid=\"c5a32dfd6e1692777197db92b6aea1\">radiotracer</span> into the <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XxBMWs0Fqij6tvr9Gb671749124378.mp3", "video": ""}, {"text": "A 6-week-old infant presents with persistent jaundice and acholic stools. After initial workup, a congenital hepatobiliary disorder is suspected. Intraoperative cholangiography reveals complete obliteration of the common bile duct, cystic duct, and hepatic duct up to the porta hepatis. Based on the Kasai Classification, which type of this condition does this infant have?", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2A", "correct": false}, {"label": "C", "text": "Type 2B", "correct": false}, {"label": "D", "text": "Type 3", "correct": true}], "correct_answer": "D. Type 3", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of both <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> &amp; <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1:1000 live births</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common indication of <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> liver transplantation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathological Hallmarks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> proliferation</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"77786ce4911692777184f875836332\">cholestasis</span> with plugging</li>\n<li>Inflammatory cell infiltrate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progresses to:</p>\n<ul>\n<li>Cirrhosis</li>\n<li>Portal hypertension</li>\n<li>Hepatic failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #808080; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Kasai Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Type 1:</strong> Common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CBD) is obliterated with patent <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> &amp; <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <strong>(Option A)</strong></li>\n<li><strong>Type 2A: </strong>Characterized by <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> of Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CHD) with patent <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> &amp; CBD <strong>(Option B)</strong></li>\n<li><strong>Type 2B:</strong> Characterized by <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of CHD, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> &amp; CBD <strong>(Option C)</strong></li>\n<li><strong>Type 3 (MC type):</strong> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">Atresia</span> of CBD, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> &amp; <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> up to <span class=\"customMeta\" data-dictid=\"772ce52d0d16927771969aeeb6731a\">Porta</span> hepatis (responsible &gt; 90% of the cases) <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lAr8qLzBOy96OKd23ktt1749122585.mp3", "video": ""}, {"text": "A newborn is diagnosed with Type A Tracheoesophageal fistula (TEF). The surgical team is discussing treatment options based on the gap between the proximal and distal ends of the esophagus. On further investigations, the gap is considerably larger. Which of the following will be the correct management for this patient?", "options": [{"label": "A", "text": "Tension-free Esophago-Esophagostomy", "correct": false}, {"label": "B", "text": "Feeding gastrostomy followed by tension free Esophago-Esophagostomy", "correct": true}, {"label": "C", "text": "Excision of fistula tract + Tension-free esophago-esophagostomy.", "correct": false}, {"label": "D", "text": "Excision of fistula tract + repair of the defect.", "correct": false}], "correct_answer": "B. Feeding gastrostomy followed by tension free Esophago-Esophagostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eWaudJ2hcLG4JlMY147Z1740042577.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Protocol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confirm diagnosis of TEF</li>\n<li>Determine the type of TEF (A, B, C, D, or E)</li>\n<li>Assess for associated anomalies (VACTERL)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inability to pass a <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube into the stomach, with coiling in the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> suggests <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> (EA)</li>\n<li>Presence of gas in GIT below the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> is suggestive of TEF</li>\n<li>For type E or H-type <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> diagnosis is confirmed by:\n\t\t\t\t<ul>\n<li>Tracheo-bronchoscopy (for the evaluation of the trachea)</li>\n<li>Upper GI <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> (For the assessment of the esophagus)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For <span class=\"customMeta\" data-dictid=\"10b0d1c12d16927772018830011368\">Type A</span> TEF (Isolated <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> without TEF):</strong></p>\n<ul>\n<li><strong>a. For small gap: </strong><strong>(Option A)</strong>\n<ul>\n<li>Perform tension-free Esophago-Esophagostomy</li>\n<li>Suture <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ends</li>\n</ul>\n</li>\n<li><strong>b. For large gap:</strong>\n<ul>\n<li>Perform <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> gastrostomy</li>\n<li>Follow with delayed tension-free Esophago-Esophagostomy</li>\n</ul>\n</li>\n</ul>\n<p><strong>For Types B, C, and D TEF (TEF with <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> atresia):</strong><strong> (Option C)</strong></p>\n<ul>\n<li>Excision of <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tract</li>\n<li>Perform tension-free esophago-esophagostomy</li>\n</ul>\n<p><strong>For Type E TEF (TEF without <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> atresia): </strong><strong>(Option D)</strong></p>\n<ul>\n<li>Excision of <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tract</li>\n<li>Repair of the defect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mortality of TEF depends on the abnormalities:</p>\n<ul>\n<li>Cardiac defects</li>\n<li>Chromosomal abnormalities</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mY2N5CoNg5gzkoDq56by1749122425.mp3", "video": ""}, {"text": "A newborn male presents with continuous drooling of saliva from the mouth and regurgitation of feeds given orally. When attempting to pass a nasogastric tube, the physician notices that it coils in the esophagus and cannot be passed into the stomach. X-ray reveals the presence of gas in the gastrointestinal tract below the diaphragm. Further evaluation reports the presence of cardiovascular abnormality. Which of the following cardiac abnormalities is most likely to be seen?", "options": [{"label": "A", "text": "Ventricular septal defect (VSD)", "correct": true}, {"label": "B", "text": "Patent ductus arteriosus (PDA)", "correct": false}, {"label": "C", "text": "Tetralogy of Fallot (TOF)", "correct": false}, {"label": "D", "text": "Atrial septal defect (ASD)", "correct": false}], "correct_answer": "A. Ventricular septal defect (VSD)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8B5oqydAdDnWXWtZYaSp1740042513.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fistula: <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">Abnormal</span> communication between 2 epithelialized surfaces</li>\n<li>TEF: <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">Abnormal</span> communication between <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> &amp; esophagus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Esophageal atresia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Type A:</strong> Isolated <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> without TEF</li>\n<li><strong>Type B:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> TEF</li>\n<li><strong>Type C:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (Most common type)</li>\n<li><strong>Type D:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with both <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> + <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (Least common type)</li>\n<li><strong>Type E:</strong> TEF without <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> or H-shaped fistula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maternal history of Polyhydramnios</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Continuous drooling of <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> from the mouth</li>\n<li>Regurgitation of feeds given orally</li>\n<li>If food or <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> enters the trachea:\n\t\t\t\t<ul>\n<li>Choking</li>\n<li>Coughing</li>\n<li>Cyanosis</li>\n<li>Dyspnea</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inability to pass a <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube into the stomach, with coiling in the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> suggests <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> (EA)</li>\n<li>Presence of gas in GIT below the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> is suggestive of TEF</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Abnormalities (VACTERL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>V</strong>ertebral body <span class=\"customMeta\" data-dictid=\"aa998dc528169277719850af075181\">segmentation</span> defect</li>\n<li><strong>A</strong>nal atresia</li>\n<li><strong>C</strong>ardiovascular anomalies (VSD, PDA): M/C anomaly.\n\t\t\t\t<ul>\n<li><strong>Ventricular septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> </strong>(VSD): M/C among <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> defects</li>\n</ul>\n</li>\n<li><strong>TE</strong>F</li>\n<li><strong>R</strong>enal <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> (Unilateral <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> agenesis)</li>\n<li><strong>L</strong>imb anomalies (Radial <span class=\"customMeta\" data-dictid=\"9c086ce80c1692777197e81a8c2d9f\">ray</span> hypoplasia)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/saX0iiFg9dobARC4F3tX1749122254.mp3", "video": ""}, {"text": "A 45-year-old man presents with progressive dyspnea on exertion. Chest X-ray shows an elevated left hemidiaphragm. Further imaging reveals thinning and upward displacement of the left hemidiaphragm without any defect. What is the most appropriate management?", "options": [{"label": "A", "text": "Observation and follow-up", "correct": false}, {"label": "B", "text": "Plication of the diaphragm", "correct": true}, {"label": "C", "text": "Mesh repair", "correct": false}, {"label": "D", "text": "Pneumoperitoneum induction", "correct": false}], "correct_answer": "B. Plication of the diaphragm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qdNkWHyDESFhgsHSTHIb1740042462.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8POHkFv2VuvKTkDhTtrx1749121928.mp3", "video": ""}, {"text": "A 20-year-old female presents with recurrent hemoptysis. CT angiography reveals a dense lesion in the left lower lobe with arterial supply from the descending thoracic aorta. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Intralobar pulmonary sequestration", "correct": true}, {"label": "B", "text": "Extralobar pulmonary sequestration", "correct": false}, {"label": "C", "text": "Bronchogenic cyst", "correct": false}, {"label": "D", "text": "Congenital cystic adenomatoid malformation", "correct": false}], "correct_answer": "A. Intralobar pulmonary sequestration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lQ3qH231CsFco33beGBY1740042417.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Intralobar <span class=\"customMeta\" data-dictid=\"dd02fbdad81692777198e605d5fbd2\">sequestration</span> (ILS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extralobar <span class=\"customMeta\" data-dictid=\"dd02fbdad81692777198e605d5fbd2\">sequestration</span> (ELS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common (75-90% of cases)</li>\n<li>Located within normal lung tissue</li>\n<li>Shares pleural covering with the normal lung</li>\n<li>Usually diagnosed in adolescents or young adults</li>\n<li>Common symptoms: <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> pneumonia, hemoptysis</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is typically to the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> veins</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less common (10-25% of cases)</li>\n<li>Separate from normal lung tissue with its own pleural covering</li>\n<li>Usually diagnosed in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> or early childhood</li>\n<li>Often associated with other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is typically to the <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> veins (Azygos, Hemiazygos vein, Venacava)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bpDZguUgcBKloerTlxJk1749121747.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is the correct definition of shock?", "options": [{"label": "A", "text": "A state of low tissue perfusion inadequate for normal cellular respiration.", "correct": true}, {"label": "B", "text": "A state of high tissue perfusion inadequate for normal cellular respiration.", "correct": false}, {"label": "C", "text": "A state of low tissue perfusion adequate for normal cellular respiration.", "correct": false}, {"label": "D", "text": "None of the above.", "correct": false}], "correct_answer": "A. A state of low tissue perfusion inadequate for normal cellular respiration.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypovolemic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced circulating blood volume</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemorrhage, Dehydration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiogenic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Failure of the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> pump</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myocardial Infarction, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Dysrhythmias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> filling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac Tamponade, Tension Pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distributive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> leading to organ hypoperfusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Septic Shock, Anaphylactic Shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination of hypovolemic, cardiogenic, or distributive shock mechanisms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Addisonian Crisis, <span class=\"customMeta\" data-dictid=\"a856fbe9fc1692777193631fa87f91\">Myxedema</span> Coma</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5eWoIktyqQB86bh6pocy1747213668.mp3", "video": ""}, {"text": "A 25-year-old male patient was brought with multiple injuries on his body following a road traffic accident. O/E patient was drowsy and confused, extremities were cold and clammy, weak thready pulse noted. On auscultation, tachypnoea and tachycardia observed. Identify the type of shock seen in this patient.", "options": [{"label": "A", "text": "Hypovolemic shock", "correct": true}, {"label": "B", "text": "Distributive shock", "correct": false}, {"label": "C", "text": "Neurogenic shock", "correct": false}, {"label": "D", "text": "Cardiogenic shock", "correct": false}], "correct_answer": "A. Hypovolemic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PGruycNjhTukh76AAGtG1740042014.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pqnbNdqVcGsRy7o2Dg3F1747213823.mp3", "video": ""}, {"text": "A 45-year-old male patient was brought to the emergency department following a road traffic accident.O/E, he had multiple injuries all over his body and was found to be in class III hemorrhagic shock. The percentage of blood loss would be between:", "options": [{"label": "A", "text": "5-15%", "correct": false}, {"label": "B", "text": "30-40%", "correct": true}, {"label": "C", "text": "&amp;gt;40%", "correct": false}, {"label": "D", "text": "15-30%", "correct": false}], "correct_answer": "B. 30-40%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class I (Compensated Shock)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class II (Hypoxemia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IV (Refractory Shock)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 15%<strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30% <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40%<strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 40%<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compensatory mechanisms maintain <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized vasoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decompensated shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;100/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-120/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>120-140/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;140/min</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-15 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mental Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert, normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anxious, mildly agitated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused, altered mental status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comatose, lethargic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9mRKgj0Sc7GQfOVz0gxQ1747214084.mp3", "video": ""}, {"text": "Following a road traffic accident, a 23-year-old man presents with multiple injuries on his body and the percentage of blood loss is &amp;lt;15%. Identify which class of ATLS classification it belongs to.", "options": [{"label": "A", "text": "Class 1", "correct": true}, {"label": "B", "text": "Class 2", "correct": false}, {"label": "C", "text": "Class 3", "correct": false}, {"label": "D", "text": "Class 4", "correct": false}], "correct_answer": "A. Class 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood loss (%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-15%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 40%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central Nervous System (CNS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slightly anxious</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mildly anxious</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anxious or confused</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused or lethargic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulse (beats/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 120</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 140</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulse pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory rate (breaths/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>14-20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 35</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine output (mL/hr)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 30</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negligible/Nil</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid requirement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crystalloid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crystalloid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crystalloid + Blood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crystalloid + Blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Base deficit (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 to -2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-2 to -6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-6 to -10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-10 or less</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NOOwEyX37j8NRP3DG3Hv1747214210.mp3", "video": ""}, {"text": "A 62-year-old male with a history of hypertension and type 2 diabetes presents with chest pain. His ECG shows ST-segment elevation in the anterior leads. Despite initial treatment, his condition deteriorates with low blood pressure, rapid heart rate, and difficulty breathing. Examination reveals elevated jugular venous pressure (JVP) and crackles on lung auscultation. What type of shock is this patient most likely experiencing?", "options": [{"label": "A", "text": "Cardiogenic shock", "correct": true}, {"label": "B", "text": "Obstructive shock", "correct": false}, {"label": "C", "text": "Hypovolemic shock", "correct": false}, {"label": "D", "text": "Septic shock", "correct": false}], "correct_answer": "A. Cardiogenic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vjqJKpHmFWTwoPjabN2P1740042054.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systolic Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">Infarction</span> (MI)</li>\n<li>Myocardial Depressants:</li>\n</ul>\n<ol>\n<li>Calcium Channel Blockers (CCBs)</li>\n<li>Beta Blockers</li>\n<li>Anti-arrhythmic drugs</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diastolic Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular Hypertrophy</li>\n<li>Restrictive Cardiomyopathy</li>\n<li>Cardiac Tamponade</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valvular Structural Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Papillary Muscle Rupture</li>\n<li>Aortic Regurgitation (AR)</li>\n<li>Mitral Regurgitation (MR)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arrhythmias</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular Tachyarrhythmia<br/>\n\t\t\t\t </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/a3OtxDSt5qkw3pzxZrIr1747214438.mp3", "video": ""}, {"text": "A patient admitted to the hospital with a urinary tract infection develops oliguria and lightheadedness on the third day of admission. His peripheries are warm, capillary refill is brisk, and his blood pressure is noted to be 86/56 mmHg despite fluid resuscitation. What type of shock is this patient likely experiencing?", "options": [{"label": "A", "text": "Hypovolemic shock", "correct": false}, {"label": "B", "text": "Septic shock", "correct": true}, {"label": "C", "text": "Obstructive shock", "correct": false}, {"label": "D", "text": "Cardiogenic shock", "correct": false}], "correct_answer": "B. Septic shock", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uscJEC9St6IBIYymYZEI1747214953.mp3", "video": ""}, {"text": "A 42-year-old man is brought after a high-impact motor vehicle accident. On examination, he has a spinal cord injury at the level of T6 with flaccid paralysis of the lower extremities. His vital signs show hypotension, bradycardia, and warm, flushed skin. Which of the following is the most likely underlying pathophysiologic mechanism for his shock state?", "options": [{"label": "A", "text": "Decreased cardiac output", "correct": false}, {"label": "B", "text": "Decreased blood volume", "correct": false}, {"label": "C", "text": "Increased vascular permeability", "correct": false}, {"label": "D", "text": "Decreased peripheral vascular resistance", "correct": true}], "correct_answer": "D. Decreased peripheral vascular resistance", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xhBHLdduPZ9KHOfx6U9R1747136916.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TpixDlsG7juIs0deuzfz1747215125.mp3", "video": ""}, {"text": "A 28-year-old male presents with a sudden onset of severe fatigue, weakness, nausea, vomiting, and abdominal pain. On examination, he is hypotensive (BP 75/45 mmHg), tachycardic (HR 115 bpm), and has noticeable diffuse skin hyperpigmentation, especially in sun-exposed areas and palmar creases. Laboratory results reveal: Sodium: 128 mEq/L Potassium: 5.8 mEq/L Glucose: 58 mg/dL What is the most likely diagnosis?", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "B", "text": "Septic shock", "correct": false}, {"label": "C", "text": "Addison's disease", "correct": true}, {"label": "D", "text": "Panhypopituitarism", "correct": false}], "correct_answer": "C. Addison's disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OT7oqZGvGDWOvtNIkrbQ1747215431.mp3", "video": ""}, {"text": "A 55-year-old patient is brought to the emergency department with severe abdominal pain, tachycardia, and hypotension. Examination reveals pale, cool, and clammy skin with delayed capillary refill. The patient has oliguria. Which of the following hemodynamic profiles is most characteristic of this patient's condition?", "options": [{"label": "A", "text": "SVR - ↓ ; CO - ↑ ; CVP - Normal or ↑", "correct": false}, {"label": "B", "text": "SVR - ↑ ; CO - ↓ ; CVP - ↓", "correct": true}, {"label": "C", "text": "SVR - ↓ ; CO - ↓ ; CVP - ↑", "correct": false}, {"label": "D", "text": "SVR - ↑ ; CO - ↑ ; CVP - ↑", "correct": false}], "correct_answer": "B. SVR - ↑ ; CO - ↓ ; CVP - ↓", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ns8u1iw4chttOruIumhU1747215621.mp3", "video": ""}, {"text": "A 65-year-old patient presents with sudden onset of shortness of breath, tachycardia, and hypotension. Examination reveals cool, clammy skin, and delayed capillary refill. The most appropriate initial management strategy for this patient's condition would be :", "options": [{"label": "A", "text": "Fluid resuscitation with normal saline and initiation of norepinephrine", "correct": true}, {"label": "B", "text": "Fluid resuscitation with Ringer's lactate and initiation of dobutamine", "correct": false}, {"label": "C", "text": "Fluid resuscitation with normal saline and initiation of dopamine", "correct": false}, {"label": "D", "text": "Fluid resuscitation with Ringer's lactate and initiation of epinephrine", "correct": false}], "correct_answer": "A. Fluid resuscitation with normal saline and initiation of norepinephrine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal/Target Value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shock Indicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure (Systolic BP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 90 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 90 mmHg or a drop &gt; 40 mmHg from baseline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> and decreased <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> to vital organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mean <span class=\"customMeta\" data-dictid=\"9e831262a7169277718263c34e2dc1\">Arterial Pressure</span> (MAP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 65 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 65 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MAP below 65 mmHg may result in inadequate organ perfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate (HR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60-100 bpm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 100 bpm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia is a <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> response to maintain perfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 0.5 mL/kg/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 0.5 mL/kg/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output indicates <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> hypoperfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactate Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-1 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> suggests <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and hypoxia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">Oxygen Saturation</span> (ScvO2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>70-75%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 70%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> between oxygen delivery and consumption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin Temperature &amp; <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">Capillary</span> Refill</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Warm, <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> refill &lt; 2 seconds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cold, clammy skin, <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> refill &gt; 2 seconds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suggests poor <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> and possible shock.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug of Choice (DOC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypovolemic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intravenous fluids (crystalloids or colloids)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restore <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> volume</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood products if hemorrhagic shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiogenic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inotropes (e.g., Dobutamine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improve <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> contractility</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasopressors (e.g., Norepinephrine) if <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> persists</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distributive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasopressors (e.g., Norepinephrine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Counteract <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> and increase <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasopressin as a second-line agent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treat underlying cause (e.g., <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">thrombolysis</span> for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism, <span class=\"customMeta\" data-dictid=\"8a6193fd7a16927771959ef051f07a\">pericardiocentesis</span> for <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Address the cause of obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intravenous fluids and vasopressors as needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anaphylactic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potent <span class=\"customMeta\" data-dictid=\"52abfe100916927772011ad20f3fda\">vasoconstrictor</span> and bronchodilator</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antihistamines, corticosteroids</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/V76LrfUzQR51pvcdm7yQ1747215818.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old patient undergoes a mastectomy for breast cancer. Post-operatively, the surgeon decides to use a closed suction drain. Which of the following drain types is shown in the image below?", "options": [{"label": "A", "text": "Penrose drain", "correct": false}, {"label": "B", "text": "Jackson Pratt drain", "correct": true}, {"label": "C", "text": "Romovac suction drain", "correct": false}, {"label": "D", "text": "Hemovac drain", "correct": false}], "correct_answer": "B. Jackson Pratt drain", "question_images": ["https://image.prepladder.com/content/ku3OR7kNzPky6Y3BTAmX1740136971.png"], "explanation_images": ["https://image.prepladder.com/content/3Gf6xu3fFtZg9yMAi9qK1740137903.png", "https://image.prepladder.com/content/GXefcp8lFUKBBAdnQHEk1740139198.png", "https://image.prepladder.com/content/npvv46LcyXSiwegnystt1740139374.png", "https://image.prepladder.com/content/B1aPADD1vSuEGe17eKaF1740139981.png", "https://image.prepladder.com/content/o3zWXrjKA9K3bmDMYAVZ1740140328.png"], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:701px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Penrose drain </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">This is an open, <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> drain consisting of a soft rubber tube. It relies on gravity and <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> action for drainage.</p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"Belzunegui T, Louis CJ, Torrededia L, Oteiza J \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Penrose_drain#/media/File:Compartment_syndrome_in_the_hand_Intraoperative_image_of_the_dorsal_region_of_the_right_hand.png\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/GXefcp8lFUKBBAdnQHEk1740139198.png\" width=\"528\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Jackson-pratt drain </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Consists of a soft, flattened <span class=\"customMeta\" data-dictid=\"a4609c06fd16927771983dad60e1a3\">silicone</span> tube connected to a soft plastic bulb</p>\n<p style=\"text-align: center;\">The bulb can be compressed to create negative pressure</p>\n<p style=\"text-align: center;\">Suitable for various surgeries, including breast, plastic, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> procedures</p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"na\" data-hash=\"\" data-license=\"na\" data-source=\"na\" data-tags=\"\" height=\"457\" src=\"https://image.prepladder.com/content/npvv46LcyXSiwegnystt1740139374.png\" width=\"400\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Romovac <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> drain </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Another type of closed <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> drain</p>\n<p style=\"text-align: center;\">Uses a spring-loaded mechanism to create constant negative pressure</p>\n<p style=\"text-align: center;\">Often used in <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> surgeries and joint replacements</p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"Sahay, Shailesh &amp; Kesarwani, Pawan &amp; Sharma, G. &amp; Tiwari, A..\" data-hash=\"\" data-license=\"CC BY-NC SA 4.0\" data-source=\"https://www.researchgate.net/figure/Picture-of-suction-drain-set-Its-metallic-trocar-was-used-to-create-the-shunt-Figure-2_fig1_376971997\" data-tags=\"\" height=\"575\" src=\"https://image.prepladder.com/content/B1aPADD1vSuEGe17eKaF1740139981.png\" width=\"400\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hemovac drain </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">This is another brand of closed <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> drain, similar in principle to the JP drain. However, Hemovac drains typically have a larger, more rigid collection chamber compared to the soft, compressible bulb of the JP</p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"na\" data-hash=\"\" data-license=\"na\" data-source=\"na\" data-tags=\"\" height=\"391\" src=\"https://image.prepladder.com/content/o3zWXrjKA9K3bmDMYAVZ1740140328.png\" width=\"400\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DtjMpOX65WBFN8Ahxp6J1747155457.mp3", "video": ""}, {"text": "A 6-month-old infant is admitted with severe vomiting and requires placement of a gastric tube. The nurse sets up the feeding equipment as shown in the image. Which of the following tubes is correctly depicted in the image?", "options": [{"label": "A", "text": "Nasogastric tube", "correct": false}, {"label": "B", "text": "Infant feeding tube", "correct": true}, {"label": "C", "text": "Orogastric tube", "correct": false}, {"label": "D", "text": "Jejunal feeding tube", "correct": false}], "correct_answer": "B. Infant feeding tube", "question_images": ["https://image.prepladder.com/content/UGq7Q8G5XM7IUN7CAo3t1740140530.png"], "explanation_images": ["https://image.prepladder.com/content/m3SsYfEHVcOnQxRE27911740140603.png", "https://image.prepladder.com/content/Gct6U004Fd98rTublWiV1740141113.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8IRG6dnUIATwLeDvijwJ1749028883.mp3", "video": ""}, {"text": "A 45-year-old patient undergoes a choledochotomy for the removal of common bile duct stones. The surgeon decides to use the given tube during the procedure. Which of the following statements best describes its correct use and function in this scenario?", "options": [{"label": "A", "text": "It is inserted to provide long-term biliary drainage and should be left in place for several months.", "correct": false}, {"label": "B", "text": "It acts as a stent and is retained for 4-6 weeks in the distal filling defect.", "correct": true}, {"label": "C", "text": "It is used to create a biliary-enteric anastomosis and is removed immediately after surgery.", "correct": false}, {"label": "D", "text": "It is placed to perform intraoperative cholangiography and is removed before closing the incision.", "correct": false}], "correct_answer": "B. It acts as a stent and is retained for 4-6 weeks in the distal filling defect.", "question_images": ["https://image.prepladder.com/content/VZ5ciB8gNCoD5IcjTCBY1740141334.png"], "explanation_images": ["https://image.prepladder.com/content/7XfPXLX8AgMm1aRYK4dz1740141443.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UK4tdrzKOrvY31OfOgrQ1749029111.mp3", "video": ""}, {"text": "A 45-year-old patient with a history of cirrhosis presents to the emergency department with massive hematemesis. The physician uses an instrument given in the picture below. Which of the following statements is correct with respect to use of this device?", "options": [{"label": "A", "text": "This instrument is commonly used if variceal bleeding does not stop by banding/sclerotherapy/gluing.", "correct": true}, {"label": "B", "text": "The esophageal balloon is inflated first with 30-40 mmHg pressure, followed by gastric balloon inflation with 400 mL of air.", "correct": false}, {"label": "C", "text": "It is a definitive treatment and does not require further procedures like banding or sclerotherapy.", "correct": false}, {"label": "D", "text": "The most common complication associated with its use is pressure necrosis of esophageal mucosa.", "correct": false}], "correct_answer": "A. This instrument is commonly used if variceal bleeding does not stop by banding/sclerotherapy/gluing.", "question_images": ["https://image.prepladder.com/content/gYXnvfADNi8dUjvAUYA61740141869.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Aspect</th>\n<th>Details</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Purpose</td>\n<td>Temporary control of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> varices</td>\n</tr>\n<tr>\n<td>Indications</td>\n<td>Bleeding uncontrolled by <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> treatment</td>\n</tr>\n<tr>\n<td>Balloon inflation order</td>\n<td>Gastric balloon first, then <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> balloon</td>\n</tr>\n<tr>\n<td>Definitive treatments</td>\n<td>Endoscopic banding, sclerotherapy, TIPS</td>\n</tr>\n<tr>\n<td>Common complications</td>\n<td>Aspiration <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> (most common), mucosal ulceration, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> rupture</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/D2Vg5a5MLOqG1hw8VI0Q1749029763.mp3", "video": ""}, {"text": "A 60-year-old man with a history of alcoholic cirrhosis presents to the emergency department with massive hematemesis. After initial stabilization, the decision is made to use the following device, as given in the picture below, for temporary management of suspected bleeding gastric varices. Which of the following statements about the device is INCORRECT?", "options": [{"label": "A", "text": "The device shown in the picture is Sengstaken-Blakemore tube", "correct": true}, {"label": "B", "text": "It contains three lumens consisting of Esophageal and gastric aspiration port, and a port for balloon inflation", "correct": false}, {"label": "C", "text": "It has a single gastric balloon with capacity 500-600cc", "correct": false}, {"label": "D", "text": "It is used for temporary management of bleeding gastric varices", "correct": false}], "correct_answer": "A. The device shown in the picture is Sengstaken-Blakemore tube", "question_images": ["https://image.prepladder.com/content/TCRJvdbUbiWUhYRESd2W1740142506.png"], "explanation_images": ["https://image.prepladder.com/content/A4N1FLn0JjQmGkNd9E2G1740142657.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cfTzRgV1dvdklCNcWMKM1749030076.mp3", "video": ""}, {"text": "Which of the following statements about the following instrument in the image is incorrect?", "options": [{"label": "A", "text": "The catheter is coated with silicone to minimize irritation during prolonged use.", "correct": false}, {"label": "B", "text": "For self-retaining purposes, the balloon is inflated with 20-30 ml of saline.", "correct": false}, {"label": "C", "text": "It can be used for administration of intravesical chemotherapy", "correct": false}, {"label": "D", "text": "2-way foley’s catheter can be used for bladder irrigation following TURP", "correct": true}], "correct_answer": "D. 2-way foley’s catheter can be used for bladder irrigation following TURP", "question_images": ["https://image.prepladder.com/content/fIKjjoG1HdR2valmFZ3B1740143288.png"], "explanation_images": ["https://image.prepladder.com/content/OCLKrOlg4oy3mJQ6uMuc1740143435.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Material</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LATEX - </strong>Less <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> &amp; <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> formation</li>\n<li><strong>Silicone Coating-</strong> For Prolonged use (upto 3 months) <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2-way Foley catheter</li>\n<li>3-way Foley catheter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Channels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2-way Foley catheter:</strong></p>\n<ul>\n<li>Main channel: For <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of urine</li>\n<li>Small channel: For inflating balloon</li>\n</ul>\n<p><strong>3-way Foley catheter:</strong></p>\n<ul>\n<li>Main channel: for <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of urine</li>\n<li>Additional channel for irrigation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Balloon Inflation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>20-30 ml <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for self-retaining <strong>(Option B)</strong></li>\n<li>30-50 ml of <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> effect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sizes (French scale)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pediatric patients</strong>: 4, 6, 8, 10</li>\n<li><strong>Adult patients: </strong>12, 14, 16, 18</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Size Calculation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Outer <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> in mm = Fr/3 (Fr - French units)</li>\n<li>E.g, if the size of the <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> is 18 French, then <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> = 18/3 = 6mm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To relieve <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention</li>\n<li>To measure <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n<li>For administration of <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> <strong>(Option C)</strong></li>\n<li>3 ways <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> - for <span class=\"customMeta\" data-dictid=\"ea6a429a6b1692777190801502ba55\">Irrigation</span> after TURP</li>\n<li>May be used for supra-pubic cystostomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/X8RN2EFaEU8zuZDZoQo01749030208.mp3", "video": ""}, {"text": "A 58-year-old patient is rushed to the emergency department with symptoms of acute limb ischemia. The vascular surgeon diagnoses an arterial embolism and decides to perform an embolectomy. Which of the following catheters is specifically designed and most appropriate for this procedure?", "options": [{"label": "A", "text": "Swan-Ganz catheter", "correct": false}, {"label": "B", "text": "Fogarty Catheter", "correct": true}, {"label": "C", "text": "De-Pezzer Catheter", "correct": false}, {"label": "D", "text": "Malecot’s Catheter", "correct": false}], "correct_answer": "B. Fogarty Catheter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ign9nT85gT3BdhTGvMfk1740143755.png", "https://image.prepladder.com/content/s1nGIwSmv6BQF8yfWwwr1740143890.png", "https://image.prepladder.com/content/cpaGsVsCkITkYxn1I2JJ1740144038.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rEU5hPJhiPdZDGqPr8AA1749030334.mp3", "video": ""}, {"text": "Match the following: a. Foley’s catheter 1. b. Nelaton’s catheter 2. c. Malecot’s catheter 3. d. Red-rubber catheter 4.", "options": [{"label": "A", "text": "a-3, b-4, c-1,d-2", "correct": true}, {"label": "B", "text": "a-4, b-3, c-2, d-1", "correct": false}, {"label": "C", "text": "a-1, b-2, c-3, d-4", "correct": false}, {"label": "D", "text": "a-2, b-1, c-4, d-3", "correct": false}], "correct_answer": "A. a-3, b-4, c-1,d-2", "question_images": ["https://image.prepladder.com/content/uhPVfOIzUvj3jvKxuTei1740144630.png", "https://image.prepladder.com/content/suVEIReURJpAlbCGNiyo1740144821.png", "https://image.prepladder.com/content/7rB8sA8GibwndqnfsjYa1740144969.png", "https://image.prepladder.com/content/Bsa7bsQUn6X24yKbtTWq1740144732.png"], "explanation_images": ["https://image.prepladder.com/content/qtbsfQFROG4uBL80ggQz1740144594.png", "https://image.prepladder.com/content/RLzFaSAjDHnkKpNU9yzF1740144691.png", "https://image.prepladder.com/content/mAJnR1fDa3iZkY2bs7EH1740144789.png", "https://image.prepladder.com/content/1vKLwXBOsJzdk8mJu16x1740144920.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZnLQgMxI2kiPQG2fY9OC1749037431.mp3", "video": ""}, {"text": "All of the following are true statements regarding central venous catheters except-", "options": [{"label": "A", "text": "The tip of the catheter is situated in the inferior vena cava", "correct": true}, {"label": "B", "text": "The most dangerous complication is pneumothorax", "correct": false}, {"label": "C", "text": "Inside OT, the Internal jugular vein is the preferred vein", "correct": false}, {"label": "D", "text": "In acutely injured, critically ill patients Femoral vein is the preferred vein", "correct": false}], "correct_answer": "A. The tip of the catheter is situated in the inferior vena cava", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LLabnzFVT9Uimaf3GvkF1740145106.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ The tip is located in the superior vena cava</li><li>↳ Order of preference: Subclavian vein &gt; Internal jugular vein &gt; Femoral vein (Option D)</li><li>↳ (Option D)</li><li>↳ Inside OT: Internal jugular vein (Option C)</li><li>↳ (Option C)</li><li>↳ Outside OT: Subclavian vein</li><li>↳ Complications: catheter-related sepsis, pneumothorax (Option B)</li><li>↳ (Option B)</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YgSoXZg85Dfku6Jv0PGd1749030443.mp3", "video": ""}, {"text": "What is the size of the cannula shown in the below image?", "options": [{"label": "A", "text": "18G", "correct": true}, {"label": "B", "text": "20G", "correct": false}, {"label": "C", "text": "24G", "correct": false}, {"label": "D", "text": "26G", "correct": false}], "correct_answer": "A. 18G", "question_images": ["https://image.prepladder.com/content/qhcdhGYN9IOBxl7wV8e61740145192.png"], "explanation_images": ["https://image.prepladder.com/content/u7fpUawdLGulx5rjUdpk1740145270.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DglKZ5ijN2r55QeccLxr1749037862.mp3", "video": ""}, {"text": "All of the following about chemo-port is true, except", "options": [{"label": "A", "text": "Retained for 5 years", "correct": true}, {"label": "B", "text": "Used for chemotherapy administration", "correct": false}, {"label": "C", "text": "The catheter is placed beneath the skin", "correct": false}, {"label": "D", "text": "The veins used are the internal jugular and subclavian veins.", "correct": false}], "correct_answer": "A. Retained for 5 years", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NHVa5DIk2mhcEkHyJPgW1740145334.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0iSvAiXwBnFilz1SgzIP1749037968.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 7-year-old child presents with a headache which gets worse in the morning, associated with nausea, vomiting, and vertigo. The radiograph revealed a type of brain tumour in the 4th ventricle. Which of the following is the investigation of choice in this case?", "options": [{"label": "A", "text": "MRI", "correct": true}, {"label": "B", "text": "Ultrasonography", "correct": false}, {"label": "C", "text": "X-ray", "correct": false}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "A. MRI", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UmfoM8gC0mQCwgJlTQhk1748150863.mp3", "video": ""}, {"text": "A 40-year-old man presents with symptoms of spinal cord compression, including back pain and weakness in the legs. MRI reveals a spinal tumour. Which of the following statements about spinal tumours is NOT true?", "options": [{"label": "A", "text": "Osteoblastic metastases are often associated with prostate cancer", "correct": false}, {"label": "B", "text": "Ependymomas are the most common intramedullary tumours in adults", "correct": false}, {"label": "C", "text": "The malignant primary tumour usually involves the vertebral body", "correct": false}, {"label": "D", "text": "Most common Mets to the spine are from the Lungs", "correct": true}], "correct_answer": "D. Most common Mets to the spine are from the Lungs", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extradural Tumors (55%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metastatic Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most common spine tumours, with the most common metastases, are Breast (21%), Lung (14%), <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> (7.5%), and RCC.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteolytic Mets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung cancer, RCC, Multiple myeloma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteoblastic Mets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prostate cancer.<strong> </strong><strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Tumors (2%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteoid osteoma, osteoblastoma, chondroma, chondroblastoma, giant cell tumours, hemangioma, and <span class=\"customMeta\" data-dictid=\"6ae8d691861692777191c5157ba7b8\">lymphangioma</span> typically occur in<strong> <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> elements.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermediate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive osteoblastoma, chordoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteosarcoma, chondrosarcoma, Ewing’s sarcoma, neuroectodermal tumours, lymphoma, fibrosarcoma, and liposarcoma</li>\n<li>It usually involves the<strong> vertebral body. </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intradural Tumors (40%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extramedullary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>They arise from the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> or nerve roots.</li>\n<li>Examples include meningiomas (dural-based, often in the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> spine) and schwannomas (benign, from the nerve sheath).</li>\n<li>Neurofibromas are <span class=\"customMeta\" data-dictid=\"a288eadb79169277720330cad0aa77\">fusiform</span> and can grow within nerve roots.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intramedullary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arise within <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord parenchyma; include ependymomas (most common in adults)<strong> </strong><strong>(Option B) </strong>and astrocytomas (common in children).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MjELQdAGWMvhvxCD1bsA1748152226.mp3", "video": ""}, {"text": "A 55-year-old man with a history of immunosuppression is suspected for Primary CNS lymphoma and evaluated. Which of the following is not accurate about this condition?", "options": [{"label": "A", "text": "Often shows a dramatic but short-lived response to steroids.", "correct": false}, {"label": "B", "text": "Steroids should be withheld before biopsy.", "correct": false}, {"label": "C", "text": "Shows no response to steroids.", "correct": true}, {"label": "D", "text": "Diagnosis is confirmed with a stereotactic biopsy.", "correct": false}], "correct_answer": "C. Shows no response to steroids.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QAFoWSLaps5jxko3lYbb1748152060.mp3", "video": ""}, {"text": "A 65-year-old patient with a small brain metastasis is being considered for Stereotactic Radiosurgery (SRS). Which statement correctly describes Stereotactic Radiosurgery (SRS)?", "options": [{"label": "A", "text": "Delivers broad radiation to treat the entire brain.", "correct": false}, {"label": "B", "text": "Delivers a focused dose of radiation to the tumour from multiple angles.", "correct": true}, {"label": "C", "text": "Requires prior surgical removal of the tumour.", "correct": false}, {"label": "D", "text": "Used for large, invasive tumours needing extensive surgery.", "correct": false}], "correct_answer": "B. Delivers a focused dose of radiation to the tumour from multiple angles.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/i4OvT22LD01O6p1vf5ZM1738935767.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7KTg4Kh99MmhuDdYncVA1748151882.mp3", "video": ""}, {"text": "A 32-year-old woman visits your clinic with complaints of missed periods and noticeable visual disturbances over the past few months. She also reports frequent headaches and mild galactorrhea. MRI shows the findings given in the image. What visual defect is most commonly associated with this condition?", "options": [{"label": "A", "text": "No options available", "correct": false}], "correct_answer": "Unknown", "question_images": ["https://image.prepladder.com/content/v2avPbANKz8ngjUOxe1W1738935150.png"], "explanation_images": ["https://image.prepladder.com/content/g3D7AdbkjkH7SSXy0NNv1738935505.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/c2saMJsRzAWPTCRFYcoi1748151725.mp3", "video": ""}, {"text": "A 6-year-old child presents with headache, vomiting, blurring of vision, weakness, recent aggression, and weight gain. Examination reveals growth retardation and signs of hypopituitarism. MRI findings are noted. Which of the following is not true regarding this condition?", "options": [{"label": "A", "text": "Hypopituitarism is the characteristic feature", "correct": false}, {"label": "B", "text": "It is more common in children", "correct": false}, {"label": "C", "text": "It is derived from pituitary stalk", "correct": true}, {"label": "D", "text": "Growth retardation is also observed", "correct": false}], "correct_answer": "C. It is derived from pituitary stalk", "question_images": ["https://image.prepladder.com/content/jrUiBDXtN6T89TNv3ZNb1738934816.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IamDHpe9kMRmZkq5EEhv1748151545.mp3", "video": ""}, {"text": "A 52-year-old female patient presents with complaints of difficulty understanding speech and tinnitus. On examination, there is unilateral sensorineural hearing loss, reduced corneal sensitivity, and numbness of the face. Which of the following nerves is most commonly involved in this condition?", "options": [{"label": "A", "text": "Inferior vestibular nerve", "correct": true}, {"label": "B", "text": "Superior vestibular nerve", "correct": false}, {"label": "C", "text": "Cochlear nerve", "correct": false}, {"label": "D", "text": "Facial nerve", "correct": false}], "correct_answer": "A. Inferior vestibular nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s68EesWDnXrnKvmdOKzu1738934667.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wKSZgG1TjGeJ8WoZLvaX1748151312.mp3", "video": ""}, {"text": "A 48-year-old male presented with headache, blurring of vision, weakness and loss of balance. His radiological investigations suggested hydrocephalus and pheochromocytoma. A tumour is detected whose radiograph is given below. Which of the following genetic syndromes is most commonly associated with this condition?", "options": [{"label": "A", "text": "MEN 1 syndrome", "correct": false}, {"label": "B", "text": "VHL syndrome", "correct": true}, {"label": "C", "text": "Lynch syndrome", "correct": false}, {"label": "D", "text": "Gardner’s syndrome", "correct": false}], "correct_answer": "B. VHL syndrome", "question_images": ["https://image.prepladder.com/content/sYvqIFA9OIqB2mwnocxK1738934287.png"], "explanation_images": ["https://image.prepladder.com/content/EeAnEiGHYgRg0d9wozjz1738934411.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2p9WRgtAAGBufT7Zol3T1748151148.mp3", "video": ""}, {"text": "A 3-year-old child presented with complaints of severe morning headache associated with nausea, vomiting and seizure. On examination, the doctor suspected a brain tumour and suggested an MRI, which revealed a tumour at the vermis region. Which of the following syndromes is associated with this condition?", "options": [{"label": "A", "text": "Gorlin syndrome", "correct": false}, {"label": "B", "text": "NF1 syndrome", "correct": false}, {"label": "C", "text": "VHL syndrome", "correct": false}, {"label": "D", "text": "Turcot’s syndrome", "correct": true}], "correct_answer": "D. Turcot’s syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kfbjzxidvyAEgbDKgoXn1748150978.mp3", "video": ""}, {"text": "A 45-year-old woman presents with worsening headaches, cognitive issues, and personality changes. MRI reveals a large mass in the left frontal lobe with surrounding oedema, likely a primary brain tumour. What is the overall most common type of primary brain tumour in adults?", "options": [{"label": "A", "text": "Medulloblastoma", "correct": false}, {"label": "B", "text": "Glioblastoma", "correct": false}, {"label": "C", "text": "Meningioma", "correct": true}, {"label": "D", "text": "Oligodendroglioma", "correct": false}], "correct_answer": "C. Meningioma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Hw3XBBfrFp8uw3PJ8Wsv1748149882.mp3", "video": ""}, {"text": "A 45-year-old male presents with recurrent seizures and headaches. MRI reveals a mass located in the cerebral hemisphere. Histopathological examination of the mass shows cells with a \"fried egg\" appearance and a chicken-wire capillary pattern. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Meningioma", "correct": false}, {"label": "B", "text": "Oligodendroglioma", "correct": true}, {"label": "C", "text": "Craniopharyngioma", "correct": false}, {"label": "D", "text": "Glioblastoma", "correct": false}], "correct_answer": "B. Oligodendroglioma", "question_images": ["https://image.prepladder.com/content/tu6th47i0pZTj2S7eG0h1738926319.png"], "explanation_images": ["https://image.prepladder.com/content/WY80hLL8gtpkfztQ2ARW1739942707.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary brain tumours arise from oligodendrocytes (glial cells supporting neurons).</li>\n<li>It is often slow-growing and typically occurs in adults aged 40-50.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seizures</li>\n<li>Headaches</li>\n<li>Focal neurological deficits</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathological (HPE) Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>\"Fried-egg\" </strong>appearance of tumour cells</li>\n<li><strong>Chicken-wire capillary</strong> pattern</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MRI is preferred for diagnosis.</li>\n<li>Contrast-enhancing mass in the cerebral hemispheres</li>\n<li>It may show calcifications and oedema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgery:</strong> Aim to remove as much of the tumour as possible while preserving brain tissue.</li>\n<li><strong>5-ALA fluorescence-guided surgery:</strong> Helps visualise tumour cells for more accurate resection.</li>\n<li><strong>Chemotherapy:</strong> <span class=\"customMeta\" data-dictid=\"547a5ca0bf16927772009f74f72243\">Temozolomide</span> is commonly used.</li>\n<li><strong>Radiation Therapy:</strong> Recommended for <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">high-grade</span> tumors or when complete removal is not feasible.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prominent calcified areas and calcified margins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-defined, <span class=\"customMeta\" data-dictid=\"1dfb6906b91692777189e0acce4f86\">hyperdense</span> masses on CT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oligodendroglioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensive calcifications throughout the tumour.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distinct appearance with calcifications on MRI; \"fried-egg\" appearance on histopathology.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Craniopharyngioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains calcified <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> and solid components.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed solid and <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> components with <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> on CT and MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pilocytic Astrocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present with calcified nodules, particularly in <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> components.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-defined <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> mass with possible calcified nodules on CT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ganglioglioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may show <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> within the tumour or surrounding areas.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed solid and <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> mass on imaging, with calcified regions visible on CT.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/USLq4OS0VPRcRcpaSeTa1749130574.mp3", "video": ""}, {"text": "A 55-year-old female presents with headaches and visual disturbances. Imaging studies reveal a well-circumscribed mass in the brain. On histopathological examination, the tumour shows calcifications and cells arranged in whorls. Which of the following radiological findings is most characteristic of this tumour type?", "options": [{"label": "A", "text": "Calcified mass", "correct": false}, {"label": "B", "text": "Ring enhancement", "correct": false}, {"label": "C", "text": "Dural tail sign", "correct": true}, {"label": "D", "text": "Vasogenic oedema", "correct": false}], "correct_answer": "C. Dural tail sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LxbcN079WbEM9Yf3dVrf1738926161.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign tumours arise from the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> surrounding the brain and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headaches</li>\n<li>Visual disturbances</li>\n<li>Neurological deficits due to mass effect</li>\n<li>Vasogenic oedema (brain swelling)</li>\n<li>Potential for obstructive <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> (if <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> flow is blocked)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Contrast-enhancing mass</li>\n<li>Dural base attachment</li>\n</ul>\n<ul>\n<li>Possible calcifications</li>\n<li><strong>Dural tail sign</strong> (specific to meningiomas)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery (preferred if the tumour is large or symptomatic)</li>\n<li>Radiotherapy or <span class=\"customMeta\" data-dictid=\"f3333542581692777199584fa789d9\">stereotactic</span> <span class=\"customMeta\" data-dictid=\"493af101611692777197c3ccd81d62\">radiosurgery</span> if surgery is risky.</li>\n<li>Watch-and-wait approach for small, incidental tumours in older patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OsFltlxApTrrJApySilY1748150590.mp3", "video": ""}, {"text": "A 60-year-old patient presents with worsening headaches, focal neurological deficits, and personality changes. MRI imaging reveals a ring-enhancing lesion surrounded by significant oedema. Based on these imaging characteristics, which of the following is the most likely diagnosis and management in recurrent cases?", "options": [{"label": "A", "text": "Meningioma, Bevacizumab", "correct": false}, {"label": "B", "text": "Glioblastoma Multiforme, Temozolomide", "correct": true}, {"label": "C", "text": "Metastatic Brain Tumor, Evacizumab", "correct": false}, {"label": "D", "text": "Primary CNS Lymphoma, Doxorubicin", "correct": false}], "correct_answer": "B. Glioblastoma Multiforme, Temozolomide", "question_images": ["https://image.prepladder.com/content/76je4AhbL0uKnJeeHVJ31738925417.png"], "explanation_images": ["https://image.prepladder.com/content/0s3aWy2bJYO3oiPZVtqW1739942508.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RL7wEcEbdiRfuaNLEz9q1745396511.mp3", "video": ""}, {"text": "A 45-year-old patient presents with headaches and focal neurological deficits. Imaging reveals a tumour located in the cerebral hemispheres, characterised by infiltrative growth and low cellularity. Which of the following options best describes the likely diagnosis for this tumour?", "options": [{"label": "A", "text": "Pilocytic Astrocytoma", "correct": false}, {"label": "B", "text": "Diffuse Astrocytoma", "correct": true}, {"label": "C", "text": "Anaplastic Astrocytoma", "correct": false}, {"label": "D", "text": "Glioblastoma Multiforme", "correct": false}], "correct_answer": "B. Diffuse Astrocytoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/S2m1Cj5igSW95alKbT7c1738923985.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:714px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WHO Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pilocytic Astrocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> (children)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-circumscribed, low mitotic index</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical resection; observation or <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse Astrocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebral hemispheres</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infiltrative, low cellularity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical resection; may consider radiation or chemotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anaplastic Astrocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebral hemispheres</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High cellularity, mitotic activity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> followed by radiation and chemotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glioblastoma Multiforme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very Poor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal/temporal lobes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Necrosis, <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> proliferation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical resection, followed by radiation and <span class=\"customMeta\" data-dictid=\"547a5ca0bf16927772009f74f72243\">temozolomide</span> chemotherapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/itdRttB1NVTxa84ssfEb1747153782.mp3", "video": ""}, {"text": "A 12-year-old child presents with headaches, vomiting, and unsteady gait. Imaging reveals a mass in the posterior fossa. The lesion is surgically resected, and histology reveals a tumour with a low mitotic index. Which of the following best describes the most common location and prognosis of this tumour?", "options": [{"label": "A", "text": "Hypothalamus, Poor prognosis", "correct": false}, {"label": "B", "text": "Cerebellum, Good prognosis", "correct": true}, {"label": "C", "text": "Cerebellum, Poor prognosis", "correct": false}, {"label": "D", "text": "Hypothalamus, Good prognosis", "correct": false}], "correct_answer": "B. Cerebellum, Good prognosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KTtAXtk2TKA3caWcJbmj1738923441.png", "https://image.prepladder.com/content/hpoD3FEpdatPjxfqnLVl1738923512.png", "https://image.prepladder.com/content/4vJM1q1icBZfMNbXhHfw1738923631.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Type of Astrocytoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pilocytic Astrocytoma</p>\n<p>(Grade I)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glioblastoma Multiforme (GBM)</p>\n<p>(Grade IV)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebellum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebral hemispheres</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally good, slow-growing, often curable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor, highly aggressive, <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> survival ~15 months</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nU5r3ZNjoEF9pXze6qFm1748150356.mp3", "video": ""}, {"text": "Which type of brain tumour is most likely to cause personality changes, impaired judgment, and difficulty with motor planning?", "options": [{"label": "A", "text": "Frontal lobe tumors", "correct": true}, {"label": "B", "text": "Temporal lobe tumors", "correct": false}, {"label": "C", "text": "Occipital lobe tumors", "correct": false}, {"label": "D", "text": "Cerebellar tumors", "correct": false}], "correct_answer": "A. Frontal lobe tumors", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8hWK1C70i3p82DUvyEFA1738913960.png", "https://image.prepladder.com/content/PVEvaXu0JdkgQcLFyG7b1738914046.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VfBbQh0IQBavNFhjrwY91748150134.mp3", "video": ""}, {"text": "A 62-year-old man with a 40-pack-year smoking history presents with worsening headaches, confusion, ataxia, and right-sided weakness. A CT scan reveals multiple ring-enhancing brain lesions and further imaging identifies a mass in the right upper lobe of the lung. What is the most likely primary source of brain metastases?", "options": [{"label": "A", "text": "Colorectal cancer", "correct": false}, {"label": "B", "text": "Prostate cancer", "correct": false}, {"label": "C", "text": "Lung cancer", "correct": true}, {"label": "D", "text": "Melanoma", "correct": false}], "correct_answer": "C. Lung cancer", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/djRMjWgxMD6af3FuEmgW1748150006.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 27 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 25-year-old asymptomatic patient undergoes a routine lumbar spine X-ray for an unrelated complaint. The radiologist notices an incidental finding on the image. Which of the following findings would be inconsistent with spina bifida occulta?", "options": [{"label": "A", "text": "Tuft of hair or dimple over the affected area", "correct": false}, {"label": "B", "text": "Often asymptomatic and found incidentally on imaging", "correct": false}, {"label": "C", "text": "Failure of vertebral arches to fuse with intact spinal cord and meninges", "correct": false}, {"label": "D", "text": "Visible sac with cerebrospinal fluid and neural elements protruding through a defect", "correct": true}], "correct_answer": "D. Visible sac with cerebrospinal fluid and neural elements protruding through a defect", "question_images": ["https://image.prepladder.com/content/zaWFuiBymifjk3LjQbCQ1738907386.png", "https://image.prepladder.com/content/iseBr6zcwmg6BSkLwyiB1738907290.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:677px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Spina Bifida Occulta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Spina Bifida Aperta</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visibility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No visible <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> on the back</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visible <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> or <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> on the back</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin coverage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin covers the defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open lesion, skin discontinuity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually asymptomatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often causes neurological deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Milder form</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More severe form</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often, incidental finding on imaging.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Apparent at birth or detected prenatally</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spinal cord involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spinal cord and <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> remain within the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> canal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neural elements may protrude through defect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single type</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Meningocele</li>\n<li>Myelomeningocele</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often, it requires no treatment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually, it requires <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ognqJAAgRwvGus64N4md1747154074.mp3", "video": ""}, {"text": "A 28-year-old pregnant woman at 20 weeks of gestation undergoes a routine ultrasound, which reveals a fluid-filled sac at the lower back of the fetus. Which statement about myelomeningocele is most accurate?", "options": [{"label": "A", "text": "Protrusion of meninges through a vertebral defect", "correct": false}, {"label": "B", "text": "Sac contains cerebrospinal fluid but no neural elements.", "correct": false}, {"label": "C", "text": "Better prognosis than other spina bifida types", "correct": false}, {"label": "D", "text": "Includes spinal cord tissue within the protruding sac.", "correct": true}], "correct_answer": "D. Includes spinal cord tissue within the protruding sac.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/H0gMjEU1qDt7Qt9oxcRd1738907635.png", "https://image.prepladder.com/content/5uijGWSN9JNQFcqNsJAR1738907665.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Meningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Myelomeningocele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrusion of <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> through a vertebral <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrusion of <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord through a vertebral <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sac contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebrospinal fluid only.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebrospinal fluid and <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neural involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> elements in the <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spinal cord and/or <span class=\"customMeta\" data-dictid=\"64d06f977116927771936e3af9572f\">nerve roots</span> in the sac</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin coverage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often covered by skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually not covered by skin (open lesion)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological deficits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically mild or absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydrocephalus risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally better<strong> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally worse</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical complexity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less complex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More complex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long-term complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fewer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More frequent and severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated anomalies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/l3aIsYnWoP9phcZG1sFg1747198512.mp3", "video": ""}, {"text": "Which of the following medications, when taken during pregnancy, is most strongly associated with an increased risk of myelomeningocele in the developing fetus?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Valproic acid", "correct": true}, {"label": "C", "text": "Amoxicillin", "correct": false}, {"label": "D", "text": "Levothyroxine", "correct": false}], "correct_answer": "B. Valproic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:536px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valproic acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epilepsy, <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">Bipolar</span> disorder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carbamazepine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epilepsy, <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">Trigeminal</span> neuralgia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phenytoin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epilepsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Topiramate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epilepsy, <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">Migraine</span> prevention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methotrexate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cancer, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trimethoprim</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sulfasalazine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycophenolate mofetil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Organ transplant <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> prevention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isotretinoin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe acne</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lithium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bipolar disorder</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CByKPf9d5mCPVUN8L6Qd1747198658.mp3", "video": ""}, {"text": "Which of the following is most commonly associated with Arnold-Chiari malformation type II?", "options": [{"label": "A", "text": "Syringomyelia", "correct": false}, {"label": "B", "text": "Myelomeningocele", "correct": true}, {"label": "C", "text": "Adult-onset headaches", "correct": false}, {"label": "D", "text": "Scoliosis", "correct": false}], "correct_answer": "B. Myelomeningocele", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EUZN5ICoP4e9ojRffnKk1738908162.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chiari I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chiari II</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myelomeningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Almost always present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age at diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often adolescence/adulthood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually, <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> or prenatal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syringomyelia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More frequent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herniated structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebellar tonsils only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebellar tonsils, vermis, brainstem</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydrocephalus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very common</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/155dgkIpT1bwBs5yGK6A1747198794.mp3", "video": ""}, {"text": "Which of the following is NOT part of the classic triad of Dandy-Walker malformation?", "options": [{"label": "A", "text": "Cystic dilatation of the fourth ventricle", "correct": false}, {"label": "B", "text": "Complete or partial agenesis of the cerebellar vermis", "correct": false}, {"label": "C", "text": "Enlarged posterior fossa", "correct": false}, {"label": "D", "text": "Hydrocephalus", "correct": true}], "correct_answer": "D. Hydrocephalus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DwTFrlnbRiIYBvBGuEXe1738908329.png", "https://image.prepladder.com/content/3rmeA2jkhaEgmcHPkXpH1738908407.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/N84jRY5qen7mJUY1RAbj1747198945.mp3", "video": ""}, {"text": "A 42-year-old male presents to the emergency department after an RTA, reporting a sudden, severe headache described as the \"worst headache of his life,\" accompanied by nausea, vomiting, neck stiffness, and photophobia. A CT scan of the brain is provided. What is the most common cause of this condition?", "options": [{"label": "A", "text": "Trauma", "correct": true}, {"label": "B", "text": "Rupture of a cerebral aneurysm", "correct": false}, {"label": "C", "text": "Severe hypertension", "correct": false}, {"label": "D", "text": "Arteriovenous malformation", "correct": false}], "correct_answer": "A. Trauma", "question_images": ["https://image.prepladder.com/content/d83ZtUiqSPtI1TqFjJKv1738908578.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:525px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse SAH with layers &lt;1mm thick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localised clots or SAH layers &gt;1mm thick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SAH minimal/absent, with intracerebral/intraventricular haemorrhage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eRJwxIB9qgQgGgcykYR91747200152.mp3", "video": ""}, {"text": "A 55-year-old patient presents with a sudden severe headache, brief loss of consciousness, nausea, and vomiting. Neurological examination shows decreased consciousness and mild focal deficits. A non-contrast CT scan of the head is provided. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Subdural Hematoma (SDH)", "correct": true}, {"label": "B", "text": "Extradural Hematoma (EDH)", "correct": false}, {"label": "C", "text": "Subarachnoid Hemorrhage", "correct": false}, {"label": "D", "text": "Periventricular Hemorrhage", "correct": false}], "correct_answer": "A. Subdural Hematoma (SDH)", "question_images": ["https://image.prepladder.com/content/bRDlx13Zk4ROCjkKl2ml1738909619.png"], "explanation_images": ["https://image.prepladder.com/content/5hSwTG5S07ies3w0vj6h1738909844.png", "https://image.prepladder.com/content/oj0WpN1drHzH9eVk0sYL1738909855.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extradural Hematoma</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped</strong><strong> </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Develop over days to weeks; <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole drainage</strong><strong> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/5hSwTG5S07ies3w0vj6h1738909844.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Sharma, Dr Anand &amp; Dewan, Yashbir.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-NCCT-head-right-fronto-parietal-acute-extradural-hematoma-with-midline-shift-towards_fig1_283980160\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/oj0WpN1drHzH9eVk0sYL1738909855.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8bAP4eC09g8ECcRQebJD1747200303.mp3", "video": ""}, {"text": "A 52-year-old male with a history of hypertension and smoking presents with sudden onset of nausea, vomiting, and confusion. On examination, he has a decreased level of consciousness and neck stiffness. A non-contrast CT scan reveals subarachnoid haemorrhage. Which of the following statements about Berry aneurysms is not true?", "options": [{"label": "A", "text": "Associated with connective tissue disorders like Marfan's syndrome.", "correct": false}, {"label": "B", "text": "Absence of smooth muscle and intimal elastic lamina.", "correct": false}, {"label": "C", "text": "Most commonly seen at the bifurcation of the vertebrobasilar arteries.", "correct": true}, {"label": "D", "text": "Unruptured cases are asymptomatic", "correct": false}], "correct_answer": "C. Most commonly seen at the bifurcation of the vertebrobasilar arteries.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/noQGOCSlHSgaZWNpIhwc1738912343.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8KMdod9P5CIlwQpet5rZ1747200450.mp3", "video": ""}, {"text": "A 45-year-old man with a recent dental infection presents with persistent headaches, fever, and confusion. He exhibits focal neurological deficits and seizures. The radiological findings are provided. Given his clinical presentation and imaging, what is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Initiate IV antibiotics and immediate surgical drainage", "correct": true}, {"label": "B", "text": "Start oral antibiotics and monitor with CT every 48 hours", "correct": false}, {"label": "C", "text": "Administer high-dose corticosteroids and supportive care", "correct": false}, {"label": "D", "text": "Begin antiepileptic medications and refer for op follow-up.", "correct": false}], "correct_answer": "A. Initiate IV antibiotics and immediate surgical drainage", "question_images": ["https://image.prepladder.com/notes/YKP1AByCCxHlqukVc2A81747283122.png"], "explanation_images": ["https://image.prepladder.com/notes/YcPhWVUpLSghytGw4w9M1747283203.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xMV8E8uQ2T9Ng0S8RbgG1747200949.mp3", "video": ""}, {"text": "A 58-year-old patient presents with a significant right-sided brain tumour. During the neurological examination, the patient exhibits left-sided weakness. Which of the following best accounts for this presentation?", "options": [{"label": "A", "text": "Kernohan notch phenomenon", "correct": true}, {"label": "B", "text": "Brown-Sequard syndrome", "correct": false}, {"label": "C", "text": "Tullio phenomenon", "correct": false}, {"label": "D", "text": "Uhthoff's phenomenon", "correct": false}], "correct_answer": "A. Kernohan notch phenomenon", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qcDbShszcmIPGi8HwwjM1738913043.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/amt7ZThrtuphVvy0Kr1l1747201106.mp3", "video": ""}, {"text": "A 62-year-old man is brought to the emergency department after a fall from a ladder. He has a GCS score of 9 (E2V3M4), and his right pupil is dilated and nonreactive. The CT scan shows a large right-sided subdural hematoma with a significant midline shift to the left. BP: 180/100 mmHg, HR: 52 beats/minute with irregular breathing patterns. Which type of brain herniation is most likely occurring in this patient?", "options": [{"label": "A", "text": "Subfalcine herniation", "correct": false}, {"label": "B", "text": "Tonsillar herniation", "correct": false}, {"label": "C", "text": "Upward transtentorial herniation", "correct": false}, {"label": "D", "text": "Uncal herniation", "correct": true}], "correct_answer": "D. Uncal herniation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1asrpYPpQLwhtcuX3MvZ1738913239.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5DtSCyOum3CJoxDOlQ8w1747201505.mp3", "video": ""}, {"text": "A 62-year-old man undergoes emergent decompressive craniectomy for a large right hemispheric infarct with significant mass effect. Post-surgery, he remains comatose and, six hours later, develops pinpoint pupils and irregular breathing. A stat CT scan shows resolution of the midline shift but reveals new bilateral hyperdense lesions in the midbrain. What is the most likely explanation for these new CT findings?", "options": [{"label": "A", "text": "Contrast extravasation", "correct": false}, {"label": "B", "text": "Hemorrhagic transformation of infarct", "correct": false}, {"label": "C", "text": "Duret haemorrhage", "correct": true}, {"label": "D", "text": "Hypertensive microbleeds", "correct": false}], "correct_answer": "C. Duret haemorrhage", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/j9Drp5pvVsHVl6iKcUFe1747200678.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 7-year-old boy is brought with complaints of headache, vomiting, and neck stiffness for a few days. He had undergone a ventriculoperitoneal (VP) shunt placement for hydrocephalus a year ago. What is the most common cause of shunt malfunction in this patient?", "options": [{"label": "A", "text": "Shunt infection", "correct": false}, {"label": "B", "text": "Shunt obstruction", "correct": true}, {"label": "C", "text": "Shunt tip migration", "correct": false}, {"label": "D", "text": "Shunt disconnection", "correct": false}], "correct_answer": "B. Shunt obstruction", "question_images": ["https://image.prepladder.com/notes/caDB6C2Q6ii9eiRjKNwp1747645407.png"], "explanation_images": ["https://image.prepladder.com/notes/k2wZ668il1qjsjJp0Vgj1747645471.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the Glasgow Coma Scale (GCS) of a patient who has been admitted after a road traffic accident and is currently receiving mechanical ventilation. The patient demonstrates a response by opening their eyes upon verbal command and exhibits spontaneous movement in all four limbs.", "options": [{"label": "A", "text": "Eyes-2, Verbal-1, Motor-5", "correct": false}, {"label": "B", "text": "Eyes-2, Verbal-NT, Motor-5", "correct": false}, {"label": "C", "text": "Eyes-3, Verbal-1, Motor-6", "correct": false}, {"label": "D", "text": "Eyes-3, Verbal-NT, Motor-6", "correct": true}], "correct_answer": "D. Eyes-3, Verbal-NT, Motor-6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D.\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Behaviour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Response </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eye opening</p>\n<p>Response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneously</p>\n<p>To speech</p>\n<p>To pain</p>\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n<p>3</p>\n<p>2</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best verbal response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented to time, place and person confused</p>\n<p>Inappropriate words</p>\n<p>Incomprehensible sounds</p>\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n<p>4</p>\n<p>3</p>\n<p>2</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best motor response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n<p>Moves to <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain</p>\n<p>Flexion withdrawal from pain</p>\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n<p>Abnormal extension (decerebrate)</p>\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n<p>5</p>\n<p>4</p>\n<p>3</p>\n<p>2</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Total score:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best response</p>\n<p>Comatose client</p>\n<p>Totally unresponsive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15</p>\n<p>8 or less</p>\n<p>3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the options below is not included in the revised trauma score (RTS)?", "options": [{"label": "A", "text": "Glasgow coma scale", "correct": false}, {"label": "B", "text": "Systolic blood pressure", "correct": false}, {"label": "C", "text": "Pulse rate", "correct": true}, {"label": "D", "text": "Respiratory rate", "correct": false}], "correct_answer": "C. Pulse rate", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Revised trauma score (RTS)</strong></p>\n</td>\n<td>\n<p><strong>Trauma &amp; injury severity score (TRISS)</strong></p>\n</td>\n<td>\n<p><strong>Mangled <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">Extremity</span> severity score (MESS)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>(Mnemonic- GB Road)</p>\n<ul>\n<li>G - GCS</li>\n<li>B - Bp (systolic)</li>\n<li>Road - <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate</li>\n</ul>\n</td>\n<td>\n<p>(Mnemonic- ISS + RAM)</p>\n<ul>\n<li>SS - Injury severity score</li>\n<li><strong>R</strong> - Revised trauma score - A-Age</li>\n<li><strong>M</strong>-Mechanism (blunt/penetrating)</li>\n</ul>\n</td>\n<td>\n<p>(Mnemonic- ELISA)</p>\n<ul>\n<li>E-Energy</li>\n<li>Li- Limb Ischemia</li>\n<li>S-Shock</li>\n<li>A-Age</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A cricket player was initially hit on the head with a cricket ball, appearing fine but later collapsing, regaining consciousness to play well, and then found unconscious in the dressing room. What is the probable diagnosis based on the result of the CT scan provided?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": true}, {"label": "B", "text": "Artifact", "correct": false}, {"label": "C", "text": "Subdural hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "A. Extradural hemorrhage", "question_images": ["https://image.prepladder.com/content/B4B0hZfZOuD4oqfvYgaE1747122444.png"], "explanation_images": ["https://image.prepladder.com/content/X29IbYxy4CWDfvA1TVdb1747122469.png", "https://image.prepladder.com/content/Hyz1oV2JoofvsPXjItcE1747122470.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old man came to the clinic with a headache, palpitations, and sweating. As there is a history of renal problems in his brother and father, he requested an abdominal ultrasound, which revealed the presence of multiple renal and pancreatic cysts. 24-hour urinary metanephrine was sent, which was elevated. What is the most likely diagnosis?Multiple endocrine neoplasia type I", "options": [{"label": "A", "text": "Multiple endocrine neoplasia type I", "correct": false}, {"label": "B", "text": "Von Hippel-Lindau disease", "correct": true}, {"label": "C", "text": "Birt-Hogg-Dube syndrome", "correct": false}, {"label": "D", "text": "Tuberous sclerosis", "correct": false}], "correct_answer": "B. Von Hippel-Lindau disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for the unconscious patient brought to the casualty department following a road accident, as depicted in the provided CT scan image?", "options": [{"label": "A", "text": "Extradural hematoma (EDH)", "correct": false}, {"label": "B", "text": "Subdural hematoma (SDH)", "correct": true}, {"label": "C", "text": "Intraparenchymal bleed", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage (SAH)", "correct": false}], "correct_answer": "B. Subdural hematoma (SDH)", "question_images": ["https://image.prepladder.com/content/QutGHiTYgyOq71lTKKTA1747025534.png"], "explanation_images": ["https://image.prepladder.com/content/DrXBeUhm2vXb4EmWK1Yo1747025566.png", "https://image.prepladder.com/content/GTRAxAWgVacxutb1zvrT1747025566.png", "https://image.prepladder.com/content/2IJsmc0EABb47lH7Igwr1747025566.png", "https://image.prepladder.com/content/U4dZz2NnU2hLgfBsZO9g1747025566.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of brain haemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidural or Extradural Hematoma</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"EpiduralHematoma - Epidural hematoma - Wikipedia\" data-tags=\"\" height=\"394\" src=\"https://image.prepladder.com/content/DrXBeUhm2vXb4EmWK1Yo1747025566.png\" width=\"332\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Biconvex/lentiform shape</li>\n<li>Does not cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</li>\n<li>Cross-dural <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses</li>\n<li>Hyperdense</li>\n<li>Usually unilateral</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Typically, meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury (especially middle meningeal)</li>\n<li><strong>High-velocity trauma</strong></li>\n<li>Young patient</li>\n<li>Always traumatic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subdural Hematoma</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Subduralandherniation - Subdural hematoma - Wikipedia\" data-tags=\"\" height=\"411\" src=\"https://image.prepladder.com/content/GTRAxAWgVacxutb1zvrT1747025566.png\" width=\"331\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Crescent-shaped</li>\n<li>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</li>\n<li>Can be bilateral</li>\n<li>Don't cross <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses</li>\n<li>Follows brain surface</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bridging <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> tears</li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">Traumatic</span> or non-traumatic</li>\n<li>Elderly patients</li>\n<li>Extent of brain injury more in SDH than in EDH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intraparenchymal Hematoma</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"OpenStax College\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"File:1602 The Hemorrhagic Stroke-02.jpg - Wikimedia Commons\" data-tags=\"\" height=\"255\" src=\"https://image.prepladder.com/content/2IJsmc0EABb47lH7Igwr1747025566.png\" width=\"347\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Irregular shape within brain tissue</li>\n<li>May have surrounding oedema</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct tissue damage or coagulopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subarachnoid Haemorrhage</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage#/media/File:SubarachnoidP.png\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/U4dZz2NnU2hLgfBsZO9g1747025566.png\" width=\"260\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood in sulci/cisterns</li>\n<li>Follows CSF spaces</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trauma or <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> rupture</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old boy presents with a slow-growing, rubbery, non-tender swelling on the side of the neck, as shown in the image. Examination shows the presence of freckles and light skin patches over the face and trunk. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cystic hygroma", "correct": false}, {"label": "B", "text": "Chemodectoma", "correct": false}, {"label": "C", "text": "Neural tumour", "correct": true}, {"label": "D", "text": "Lipoma", "correct": false}], "correct_answer": "C. Neural tumour", "question_images": ["https://image.prepladder.com/notes/iHsDYUKdas9z0azMUZZl1746602538.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the Glasgow Coma Scale (GCS) of a patient admitted after a road traffic accident and receiving mechanical ventilation. The patient demonstrates a response by opening their eyes upon verbal command and exhibits spontaneous movement in all four limbs.", "options": [{"label": "A", "text": "Eyes-2, Verbal-1, Motor-5", "correct": false}, {"label": "B", "text": "Eyes-2, Verbal-NT, Motor-5", "correct": false}, {"label": "C", "text": "Eyes-3, Verbal-1, Motor-6", "correct": false}, {"label": "D", "text": "Eyes-3, Verbal-NT, Motor-6", "correct": true}], "correct_answer": "D. Eyes-3, Verbal-NT, Motor-6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D Eyes-3, Verbal-NT, Motor-6</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Eyes open without stimulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To verbal command</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eyes open in response to speech.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eyes open in response to painful stimuli.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No eye opening.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Correctly answers questions about self, location, and time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Speech is coherent but disoriented.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Random or unrelated words in response.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moaning or groaning without forming words.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No verbal sounds.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follows simple motor commands (e.g., \"Lift your arm\").</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Purposefully moves to remove painful stimulus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexion response to painful stimuli.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate posturing)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexion of arms with extension of legs in response to pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate posturing)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extension of arms and legs in response to pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No motor movement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What potential diagnosis should be considered for a patient admitted to the Emergency department following a road traffic accident exhibiting an altered level of consciousness and a Glasgow Coma Scale (GCS) score of 10, as depicted in the provided CT scan?", "options": [{"label": "A", "text": "Subdural hematoma", "correct": false}, {"label": "B", "text": "Intracerebral hemorrhage", "correct": false}, {"label": "C", "text": "Extradural hematoma", "correct": true}, {"label": "D", "text": "Hemorrhagic contusion", "correct": false}], "correct_answer": "C. Extradural hematoma", "question_images": ["https://image.prepladder.com/content/ga0MB8MxM2hJoMu8kO2R1746007893.png"], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\"&gt;Extradural&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An old lady sustained a fall and developed a headache and neurological symptoms a few days later. What is your diagnosis?", "options": [{"label": "A", "text": "Multi-infarct dementia", "correct": false}, {"label": "B", "text": "Frontal lobe meningioma", "correct": false}, {"label": "C", "text": "Korsakoff disease", "correct": false}, {"label": "D", "text": "Subdural hematoma", "correct": true}], "correct_answer": "D. Subdural hematoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hvxYZdoHzPgnao35e90t1745305603.png", "https://image.prepladder.com/notes/EvL0Fq9vcBntSw8sbCLX1746707087.png", "https://image.prepladder.com/notes/XOFlnSHBpk6Oc7E45TPm1745305855.png", "https://image.prepladder.com/notes/xsVCauwd7NC5ja9jAdJx1746707107.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Subdural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (SDH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong><strong>,</strong> often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<ul>\n<li><strong>High-energy injury:</strong> Rupture of <strong>cortical surface vessels</strong><strong>.</strong></li>\n<li><strong>Low-energy injury:</strong> <strong>Venous bleeding</strong>, common in older adults on anticoagulants.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Variable presentation depending on injury severity and timing.</li>\n<li>Signs of raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure: Headache, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse <strong>concave </strong>hyperdense (acute), <span class=\"customMeta\" data-dictid=\"7f06e594de1692777190bfb4be030b\">isodense</span> (subacute), or <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> (chronic) lesions over the brain surface, often crossing <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA062\" data-author=\"James Heilman, MD\" data-hash=\"10873\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma\" data-tags=\"April2025\" height=\"244\" src=\"https://image.prepladder.com/notes/hvxYZdoHzPgnao35e90t1745305603.png\" width=\"195\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on size, location, and clinical status:</p>\n<p>1. Large or worsening hematomas: Urgent <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> by <span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\">craniotomy</span> or craniectomy.</p>\n<p>2. Smaller, stable bleeds: Conservative management initially, with surgery if needed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman was brought to the AIIMS emergency following a road traffic accident. She was hemodynamically stable, and her GCS score was 3. She was intubated and sent for non-contrast C,T which was found to be normal. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subdural hemorrhage", "correct": false}, {"label": "B", "text": "Extradural hemorrhage", "correct": false}, {"label": "C", "text": "Diffuse axonal injury", "correct": true}, {"label": "D", "text": "Cerebral contusion", "correct": false}], "correct_answer": "C. Diffuse axonal injury", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/MmvQn8RcfnuG38SpomM01745299447.png", "https://image.prepladder.com/notes/Wfj9bITEXdFmv30u6WHV1745299499.png", "https://image.prepladder.com/notes/JsyO916cwlwsqY58XGfd1745299569.png", "https://image.prepladder.com/notes/fUFLAgxkEUvqVMEDR3HG1745299615.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse Axonal Injury (DAI)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of primary brain injury caused by widespread damage to axons due to rotational <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> forces, often associated with high-energy trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Cause</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rotational forces: High-energy accidents involving rapid <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> (e.g., motor vehicle collisions).</li>\n<li>Trauma: Blunt force impacts that cause the brain to <span class=\"customMeta\" data-dictid=\"ed17327223169277719753b0e5d6b4\">rotate</span> within the skull.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Clinical Features</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Impaired arousal</strong>: Often presents as <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> or <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness due to damage in critical brain areas (e.g., <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> activating system, <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> thalami).</li>\n<li>Neurological deficits: Poor neurological examination despite the absence of obvious radiographic global brain injury.</li>\n<li>Irreversible consequences: DAI is often associated with severe and lasting neurological impairment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Investigations</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT scan:</strong> May show hemorrhagic <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> in the <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> <span class=\"customMeta\" data-dictid=\"da26c5f3191692777183dd100bbd81\">callosum</span> and <span class=\"customMeta\" data-dictid=\"4c94b3faab16927771861e13308510\">dorsolateral</span> <span class=\"customMeta\" data-dictid=\"1f4bb4632d16927771975d96e35378\">rostral</span> <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> in severe cases.</li>\n<li><strong>MRI: </strong>\n<ul>\n<li><strong>More sensitive than CT</strong>.</li>\n<li>It shows small haemorrhages and <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> axonal injury, particularly in patients who fail to improve neurologically.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA067\" data-author=\"SBarnes\" data-hash=\"10849\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Diffuse_axonal_injury\" data-tags=\"April2025\" height=\"226\" src=\"https://image.prepladder.com/notes/MmvQn8RcfnuG38SpomM01745299447.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Postmortem examination: Confirms the diagnosis with axonal <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> and formation of <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> balls.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Prognosis</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3>Very poor due to high risk of severe disability or death due to extensive brain damage.</h3>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the classification of the head injury of a patient involved in a road traffic accident, based on a GCS score of 10?", "options": [{"label": "A", "text": "Moderate traumatic brain injury", "correct": true}, {"label": "B", "text": "Severe traumatic brain injury", "correct": false}, {"label": "C", "text": "Minor traumatic brain injury", "correct": false}, {"label": "D", "text": "Mild traumatic brain injury", "correct": false}], "correct_answer": "A. Moderate traumatic brain injury", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"1\">\n<p style=\"text-align: center;\"><strong>Eye opening </strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p style=\"text-align: center;\"><strong>Verbal response </strong></p>\n<p style=\"text-align: center;\"><strong>(Mnemonics: \"ONE CONFUSED WORD SOUNDS NOWHERE\")</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p style=\"text-align: center;\"><strong>Motor response (Best)</strong></p>\n<p style=\"text-align: center;\"><strong>(Mnemonics: \"OBEY LOCALITIES WITH <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">FLEXION</span> AND EXTENSION\")</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td>E4</td>\n<td>Spontaneous</td>\n<td>V5</td>\n<td>Oriented</td>\n<td>M6</td>\n<td>Patient obeys command</td>\n</tr>\n<tr>\n<td>E3</td>\n<td>To loud voice (Speech)</td>\n<td>V4</td>\n<td>Disoriented / confused</td>\n<td>M5</td>\n<td>Localizes pain</td>\n</tr>\n<tr>\n<td>E2</td>\n<td>To pain (Pressure)</td>\n<td>V3</td>\n<td>Inappropriate (words)</td>\n<td>M4</td>\n<td>Withdrawal to pain (there is normal flexion)</td>\n</tr>\n<tr>\n<td>E1</td>\n<td>No response</td>\n<td>V2</td>\n<td>Incomprehensible (sounds)</td>\n<td>M3</td>\n<td>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> posturing</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>V1</td>\n<td>No response</td>\n<td>M2</td>\n<td>Extension posturing</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td>M1</td>\n<td>No response</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old woman who experienced nausea and vomiting after being involved in a road traffic accident, and was brought to the emergency room unconscious, based on the findings of the NCCT brain?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": true}, {"label": "B", "text": "Subdural hemorrhage", "correct": false}, {"label": "C", "text": "Intra-parenchymal hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "A. Extradural hemorrhage", "question_images": ["https://image.prepladder.com/content/serU0N8sABLN5sAlj6Yd1746171401.png"], "explanation_images": ["https://image.prepladder.com/content/tuiMAZvqz24hfYJHXN561746171435.png", "https://image.prepladder.com/content/Y5FGJOcmUdy2P9CZ4i4A1746171435.png", "https://image.prepladder.com/content/y23bwk4Fm1H1KUYvqcui1746171435.png", "https://image.prepladder.com/content/lVxfkZZlgmslfk3cUhOz1746171435.png", "https://image.prepladder.com/content/HINbsRTzPNw86wwYNAY01746171435.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:747px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Epidural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (EDH)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subdural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (SDH) </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rupture of an artery, often the <strong>middle meningeal artery, </strong>usually due to a skull fracture, commonly in the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Two contexts:</strong></p>\n<ul>\n<li>High-energy injury: <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> of <strong>cortical surface vessels.</strong></li>\n<li>Low-energy injury: <strong>Venous bleeding,</strong> common in older adults on anticoagulants.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Classic: Transient loss of consciousness, <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval, rapid neurological decline.</li>\n<li>Headaches are common.</li>\n<li>Brain <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> signs: Contralateral hemiparesis, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> pupillary dilation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Variable presentation depending on injury severity and timing.</li>\n<li>Signs of raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure: Headache, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lentiform</strong> (lens-shaped or biconvex) <span class=\"customMeta\" data-dictid=\"1dfb6906b91692777189e0acce4f86\">hyperdense</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> between the skull and the brain.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Epidural_hematoma\" data-tags=\"\" height=\"518\" src=\"https://image.prepladder.com/content/tuiMAZvqz24hfYJHXN561746171435.png\" width=\"426\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse <strong>concave </strong>hyperdense (acute), <span class=\"customMeta\" data-dictid=\"7f06e594de1692777190bfb4be030b\">isodense</span> (subacute), or <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> (chronic) <strong>crescent-shaped</strong> lesions over the brain surface, often crossing <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma\" data-tags=\"\" height=\"492\" src=\"https://image.prepladder.com/content/Y5FGJOcmUdy2P9CZ4i4A1746171435.png\" width=\"396\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurosurgical emergency; requires immediate evacuation, usually by craniotomy.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depends on size, location, and clinical status:</p>\n<p>1. Large or worsening hematomas: Urgent <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> by <span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\">craniotomy</span> or craniectomy.</p>\n<p>2. Smaller, stable bleeds: Conservative management initially, with surgery if needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Summary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>EDH often follows a predictable course with a <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SDH has a more variable presentation and distinct CT appearance.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate course of action for the management of a patient who presents to the emergency department with a severe headache and has a blood pressure reading of 160/100 mmHg, along with a CT scan showing evidence of a subarachnoid haemorrhage?", "options": [{"label": "A", "text": "Nimodipine", "correct": false}, {"label": "B", "text": "Angiography", "correct": true}, {"label": "C", "text": "Surgery", "correct": false}, {"label": "D", "text": "Fibrinolytic therapy", "correct": false}], "correct_answer": "B. Angiography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:550px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>No bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse SAH with layers &lt;1mm thick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localised clots or SAH layers &gt;1mm thick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SAH minimal/absent, with intracerebral/intraventricular haemorrhage.</p>\n</td>\n</tr>\n</thead>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient presents with confusion and ataxia following trauma one week ago. He has a history of alcohol dependence, with his last intake 2 weeks ago. A CT scan reveals the following findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": false}, {"label": "B", "text": "Subdural hemorrhage", "correct": true}, {"label": "C", "text": "Intra-parenchymal hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "B. Subdural hemorrhage", "question_images": ["https://image.prepladder.com/content/oG4C2OfvfINnr2qPbY171745300966.png"], "explanation_images": ["https://image.prepladder.com/content/DZOX4ylRQIu3V95RFbvG1745301006.png", "https://image.prepladder.com/content/oEj8A7xBV5stzKnW4Vhc1745301006.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Extradural Hematoma</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develop over days to weeks; Acute SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Subduralandherniation - Subdural hematoma - Wikipedia\" data-tags=\"\" height=\"286\" src=\"https://image.prepladder.com/content/DZOX4ylRQIu3V95RFbvG1745301006.png\" width=\"261\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"EpiduralHematoma - Epidural hematoma - Wikipedia\" data-tags=\"\" height=\"286\" src=\"https://image.prepladder.com/content/oEj8A7xBV5stzKnW4Vhc1745301006.png\" width=\"231\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Glasgow Coma Scale (GCS) score of a patient who was admitted to the emergency room after being involved in a road traffic accident and, on examination, opens his eyes in response to a painful stimulus, speaks inappropriately, and withdraws his limbs in response to a painful stimulus?", "options": [{"label": "A", "text": "E2V2M3", "correct": false}, {"label": "B", "text": "E3V3M3", "correct": false}, {"label": "C", "text": "E2V3M4", "correct": true}, {"label": "D", "text": "E3V2M2", "correct": false}], "correct_answer": "C. E2V3M4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupil <span class=\"customMeta\" data-dictid=\"d4b70f945316927771972d75389cf0\">Reactivity</span> Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with perineural invasion?", "options": [{"label": "A", "text": "Adenoid cystic carcinoma", "correct": true}, {"label": "B", "text": "Pleomorphic adenoma", "correct": false}, {"label": "C", "text": "Mucoepidermoid tumour", "correct": false}, {"label": "D", "text": "Pancreatic cancer", "correct": false}], "correct_answer": "A. Adenoid cystic carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient had a RTA and was brought to the ER. On examination, his GCS was E2M4V2 and his CT scan is given below. Which of the following is the preferred treatment in this condition?", "options": [{"label": "A", "text": "Ventilation", "correct": false}, {"label": "B", "text": "Craniotomy with evacuation of hematoma", "correct": true}, {"label": "C", "text": "Anticoagulants", "correct": false}, {"label": "D", "text": "Steroids", "correct": false}], "correct_answer": "B. Craniotomy with evacuation of hematoma", "question_images": ["https://image.prepladder.com/content/LIffCTmyiuuo99bLoyAQ1692688656.jpeg"], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\"&gt;Craniotomy&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\"&gt;evacuation&lt;/span&gt; of h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of intracranial hemorrhage is most likely depicted in the image given below?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": false}, {"label": "B", "text": "Subarachnoid hemorrhage", "correct": false}, {"label": "C", "text": "Subdural hematoma", "correct": true}, {"label": "D", "text": "Intraparenchymal hemorrhage", "correct": false}], "correct_answer": "C. Subdural hematoma", "question_images": ["https://image.prepladder.com/content/keKfO02wUwLEyfCOxP4g1747226141.png"], "explanation_images": ["https://image.prepladder.com/content/LqhBRzGSWR1F5GKszUTL1747226386.png", "https://image.prepladder.com/content/TSSnlnkD1CTP6Kvts2421747226392.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extradural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develop over days to weeks; Acute SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"James Heilman, MD\" data-tags=\"\" height=\"279\" src=\"https://image.prepladder.com/content/LqhBRzGSWR1F5GKszUTL1747226386.png\" width=\"223\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sharma, Dr Anand &amp; Dewan, Yashbir.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-NCCT-head-right-fronto-parietal-acute-extradural-hematoma-with-midline-shift-towards_fig1_283980160\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/content/TSSnlnkD1CTP6Kvts2421747226392.png\" width=\"227\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient with a history of thromboembolic stroke, currently taking warfarin and aspirin, presents with a headache and confusion after a fall in the toilet. A non-contrast CT of the head is given in the image. What is the next best step in management?", "options": [{"label": "A", "text": "Aspirin + Clopidogrel", "correct": false}, {"label": "B", "text": "Vitamin K + FFP + Neurosurgery consultation", "correct": true}, {"label": "C", "text": "IV Mannitol", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Vitamin K + FFP + Neurosurgery consultation", "question_images": ["https://image.prepladder.com/content/qayUPuCv4contbGePUk21747292152.png"], "explanation_images": ["https://image.prepladder.com/content/FpGWyUYTOJzadQraKl7e1747292269.png", "https://image.prepladder.com/content/YkiTd4jNKOZFDlqjEHnX1747292238.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extradural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develop over days to weeks; Acute SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG\" data-tags=\"\" height=\"349\" src=\"https://image.prepladder.com/content/FpGWyUYTOJzadQraKl7e1747292269.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sharma, Dr Anand &amp; Dewan, Yashbir.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-NCCT-head-right-fronto-parietal-acute-extradural-hematoma-with-midline-shift-towards_fig1_283980160\" data-tags=\"\" height=\"283\" src=\"https://image.prepladder.com/content/YkiTd4jNKOZFDlqjEHnX1747292238.png\" width=\"240\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the next step in the management of an old patient who has undergone complete excision of glioblastoma ?", "options": [{"label": "A", "text": "Chemotherapy with Bevacizumab", "correct": false}, {"label": "B", "text": "No further management", "correct": false}, {"label": "C", "text": "Chemoradiation", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": true}], "correct_answer": "D. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Radioth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is the most common type of soft tissue sarcoma in adults?", "options": [{"label": "A", "text": "Leiomyosarcoma", "correct": false}, {"label": "B", "text": "Liposarcoma", "correct": true}, {"label": "C", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "D", "text": "Angiosarcoma", "correct": false}], "correct_answer": "B. Liposarcoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wn1TlgLUENtFm5s5uqG91739095165.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sL4HFKrgqilstOpx1fsY1747202650.mp3", "video": ""}, {"text": "A 60-year-old male presents with a rapidly enlarging mass in the retroperitoneal area. Imaging reveals a large, heterogeneous mass with areas of necrosis. A biopsy confirms the diagnosis of dedifferentiated liposarcoma . What is the most common cause of death in patients with this condition?", "options": [{"label": "A", "text": "Hemorrhage due to tumour rupture", "correct": false}, {"label": "B", "text": "Metastasis to lungs", "correct": true}, {"label": "C", "text": "Infection secondary to immunosuppression", "correct": false}, {"label": "D", "text": "Local recurrence leading to organ failure", "correct": false}], "correct_answer": "B. Metastasis to lungs", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s69eJVNvvdMomqyrksSs1739095467.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oso09qfW5T2Vgy3Y80an1747202757.mp3", "video": ""}, {"text": "Which of the following malignant tumours is known for spreading through both hematogenous and lymphatic routes?", "options": [{"label": "A", "text": "Liposarcoma", "correct": false}, {"label": "B", "text": "Leiomyosarcoma", "correct": false}, {"label": "C", "text": "Angiosarcoma", "correct": true}, {"label": "D", "text": "Rhabdomyosarcoma", "correct": false}], "correct_answer": "C. Angiosarcoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h4qTAhPtqLbaanunCAZL1739101160.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic Spread</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angiosarcoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant tumour from endothelial cells of blood vessels.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can spread via <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synovial Sarcoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arises near joints and <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sarcoma of Extremities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various sarcomas are located in limbs.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can spread to regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal Stromal Tumor (GIST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Originate from<strong> <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> cells of Cajal </strong>in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> but can spread via lymphatics.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4ZkrS90duiOTuAJ22Fn21747154449.mp3", "video": ""}, {"text": "A 45-year-old male presents with a rapidly enlarging, painless mass in his right thigh, which has been growing over a few months. The mass is firm, deep-seated, and non-tender on examination. What is the investigation of choice for diagnosing the underlying condition in this patient?", "options": [{"label": "A", "text": "Contrast-Enhanced CT (CECT)", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "Tru-cut biopsy", "correct": true}, {"label": "D", "text": "PET-CT", "correct": false}], "correct_answer": "C. Tru-cut biopsy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedure to obtain a tissue sample from a suspicious mass or tumour for histopathological examination is often used to diagnose soft tissue sarcomas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A needle is inserted into the mass under <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> guidance (e.g., ultrasound, CT) to retrieve a core of tissue for <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> analysis to determine the nature and characteristics of the tumour.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> compared to <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> biopsy.</li>\n<li>Provides sufficient tissue for accurate <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> diagnosis.</li>\n<li>Outpatient procedure with minimal recovery time.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The sample size is relatively small, potentially not representing the entire tumour if it is heterogeneous.</li>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> error leading to potential misdiagnosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zhO9baolrUCkvrUHcxZe1747202908.mp3", "video": ""}, {"text": "A 60-year-old male presents with a rapidly growing, painless mass in the upper arm. Imaging shows that the mass is located deep in the fascia, and biopsy results indicate poorly differentiated pleomorphic cells with high mitotic activity. What is the most important prognostic factor for this patient's soft tissue sarcoma?", "options": [{"label": "A", "text": "Tumor Size", "correct": false}, {"label": "B", "text": "Presence of Necrosis", "correct": false}, {"label": "C", "text": "Depth of Tumor", "correct": false}, {"label": "D", "text": "Histological Grade", "correct": true}], "correct_answer": "D. Histological Grade", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognostic Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Importance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comprehensive assessment of tumour aggressiveness;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depth of Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours deep into the <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> are more likely to be <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> and have a poorer prognosis. <strong>(Option</strong><strong> </strong><strong>C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Size of Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger tumours (&gt;5 cm) are more likely to be <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> and associated with a worse prognosis. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presence of Necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">high-grade</span> tumours with aggressive behaviour. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with a higher risk of <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> and worse prognosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perineural Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suggests aggressive behaviour and the potential for local spread</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> Margins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> if cancer cells remain at the edges of <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pPCmInXo9zBf6osWWCn81747203031.mp3", "video": ""}, {"text": "In the surgical management of soft tissue sarcoma, which of the following criteria is most appropriate for achieving optimal outcomes?", "options": [{"label": "A", "text": "Wide local excision with a 1 cm margin", "correct": false}, {"label": "B", "text": "Radical excision with removal of adjacent muscle groups", "correct": false}, {"label": "C", "text": "Wide local excision with a 2 cm margin", "correct": true}, {"label": "D", "text": "Radical excision with lymph node removal", "correct": false}], "correct_answer": "C. Wide local excision with a 2 cm margin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tXUynout5sKBtcZnMzYl1747204092.mp3", "video": ""}, {"text": "A 6-year-old boy has a rapidly growing 3 cm mass in his right cheek. Biopsy shows small round blue cells, alveolar patterns, eosinophilic cytoplasm with cross-striations, and positive immunochemistry for desmin and myogenin. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ewing sarcoma", "correct": false}, {"label": "B", "text": "Neuroblastoma", "correct": false}, {"label": "C", "text": "Rhabdomyosarcoma", "correct": true}, {"label": "D", "text": "Lymphoma", "correct": false}], "correct_answer": "C. Rhabdomyosarcoma", "question_images": ["https://image.prepladder.com/content/B66wqpUmOExcHN74dp5O1739101669.png"], "explanation_images": ["https://image.prepladder.com/content/EQ93XiEr5LRzFgGkbqyb1739101811.png", "https://image.prepladder.com/content/qyKLDCebhH4TOpYQq0gA1739101953.png", "https://image.prepladder.com/content/eWcBrbVUlKTbRmYLkIso1739102186.png", "https://image.prepladder.com/content/D2hLS4xFTpdiZc8Kjbyy1739102265.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/293ad2UtPgGAi26QluK41747204368.mp3", "video": ""}, {"text": "A 58-year-old woman is diagnosed with a high-grade retroperitoneal liposarcoma. After treatment, her oncologist monitors for metastases. What's the most common site of metastasis for retroperitoneal sarcomas?", "options": [{"label": "A", "text": "Lungs", "correct": false}, {"label": "B", "text": "Liver", "correct": true}, {"label": "C", "text": "Bone", "correct": false}, {"label": "D", "text": "Brain", "correct": false}], "correct_answer": "B. Liver", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NIY6A3Of0HFfi0SDzGBo1749131297.mp3", "video": ""}, {"text": "In unresectable or metastatic Dermatofibrosarcoma Protuberans (DFSP), which targeted therapy is considered the drug of choice?", "options": [{"label": "A", "text": "Vemurafenib", "correct": false}, {"label": "B", "text": "Imatinib", "correct": true}, {"label": "C", "text": "Pembrolizumab", "correct": false}, {"label": "D", "text": "Dabrafenib", "correct": false}], "correct_answer": "B. Imatinib", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/epOT9NmlRiRfpJPuVZIf1739104234.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TUHxQQ3H04QCv4FQtSdX1747205012.mp3", "video": ""}, {"text": "Which of the following is NOT a critical metabolic derangement typically observed in tumour lysis syndrome?", "options": [{"label": "A", "text": "Hyperkalemia", "correct": false}, {"label": "B", "text": "Hyperuricemia", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": true}, {"label": "D", "text": "Hyperphosphatemia", "correct": false}], "correct_answer": "C. Hypercalcemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JVAjI6QWjLmzcQUaVVx81739104583.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GKWfdlnhPOahZT6GpE6q1747205166.mp3", "video": ""}, {"text": "A 50-year-old male who has been taking chemotherapy for chronic leukaemia for 2 years was having shortness of breath, dizziness, and flank pain for 3 days. His investigations revealed elevated serum uric acid, phosphate and potassium levels and decreased calcium levels. Which of the following is not the management of this condition?", "options": [{"label": "A", "text": "Aggressive hydration", "correct": false}, {"label": "B", "text": "Allopurinol", "correct": false}, {"label": "C", "text": "Bisphosphonates", "correct": true}, {"label": "D", "text": "Hemodialysis", "correct": false}], "correct_answer": "C. Bisphosphonates", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BxWW3AvZEUALu683h60J1747205313.mp3", "video": ""}, {"text": "A 48-year-old male with small cell carcinoma of the lung presents with cyanosis of the neck and face, epistaxis, headache, dizziness and swelling over the face, neck and upper chest. He is irregular regarding chemotherapy sessions. Chest x-ray revealed a widening of the superior mediastinum. What is the investigation of choice in this condition?", "options": [{"label": "A", "text": "Chest x-ray", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "Ultrasound", "correct": false}, {"label": "D", "text": "CT scan", "correct": true}], "correct_answer": "D. CT scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8mtmoMwCSsZNB0kS2L6t1739105121.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bkVxsxJPecyIKwfHbEt51747205499.mp3", "video": ""}, {"text": "Which of the following statements regarding desmoid tumours is NOT true?", "options": [{"label": "A", "text": "It is often associated with FAP (familial adenomatous polyposis)", "correct": false}, {"label": "B", "text": "It arises in musculoaponeurotic structures", "correct": false}, {"label": "C", "text": "It is more common in females than males", "correct": false}, {"label": "D", "text": "Estrogen inhibits its growth", "correct": true}], "correct_answer": "D. Estrogen inhibits its growth", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dJvJojFcoWxFsmj5nWbZ1739105289.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UQr5hfn1kHgraJvkSlfy1747205671.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant . The lump has an uneven, bosselated surface , and the overlying skin is mildly ulcerated . Microscopic examination reveals the given findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumor", "correct": true}, {"label": "B", "text": "Galactocele", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": false}, {"label": "D", "text": "Paget's disease", "correct": false}], "correct_answer": "A. Phyllodes tumor", "question_images": ["https://image.prepladder.com/content/DOhXoukvwuwXNLuszAAc1741075420.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:344px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, large <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uneven, bosselated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stromal overgrowth, leaf-like pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> / mastectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which patient has better prognosis in breast cancer?", "options": [{"label": "A", "text": "Her2+", "correct": false}, {"label": "B", "text": "Triple negative", "correct": false}, {"label": "C", "text": "Luminal B", "correct": false}, {"label": "D", "text": "Luminal A", "correct": true}], "correct_answer": "D. Luminal A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\"&gt;Luminal&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with a lesion over his left ear. It slowly grew in size over the past 3 months, and he is a chronic smoker with 20 pack years. Vitals are within normal limits, and his physical examination is otherwise unremarkable. The histopathologic evaluation shows keratin pearls. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Nodular melanoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": false}, {"label": "C", "text": "Squamous cell carcinoma", "correct": true}, {"label": "D", "text": "Malignant melanom", "correct": false}], "correct_answer": "C. Squamous cell carcinoma", "question_images": ["https://image.prepladder.com/notes/ny3YuQd8BZWYNzZoNalS1747998668.png"], "explanation_images": ["https://image.prepladder.com/content/xu3zCu9U1C3eq68J0CnH1747024902.png", "https://image.prepladder.com/content/zBRLEgadyZkyIZikgLwu1747024902.png", "https://image.prepladder.com/content/LX9ySO0piJZJDepZVlgG1747024902.png", "https://image.prepladder.com/content/HxzHkGntrGsKPuhHutxZ1747024902.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Squamous cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a type of <strong>skin cancer</strong> that arises from the <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cells, which are the flat cells found in the epidermis, <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes &amp; tissues lining your organs. It is the second most common type of skin cancer after <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cell carcinoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High sunlight exposure</li>\n<li><strong>Arsenic </strong>exposure.</li>\n<li>Immunosuppression (organ transplant, HIV)</li>\n<li>Chronic lymphocytic leukemia</li>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> virus.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It commonly presents as papules, nodules, or plaques with <span class=\"customMeta\" data-dictid=\"7a14c26a7816927771904fb670c6da\">induration</span> and signs of <span class=\"customMeta\" data-dictid=\"4fcf84d1741692777195f8562d0ada\">photodamage</span> like crusting and scaling.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dermanonymous\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Squamous_Cell_Carcinoma,_Right_Upper_Cheek.png\" data-tags=\"\" height=\"291\" src=\"https://image.prepladder.com/content/xu3zCu9U1C3eq68J0CnH1747024902.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves <span class=\"customMeta\" data-dictid=\"27ac5e3413169277719548c1b36288\">physical examination</span> and biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reveals characteristic <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> pearls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary treatment involves wide <strong>surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with margins. </strong></li>\n<li><strong>Mohs micrographic surgery (MMS)</strong> aids in <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> histopathological examination.</li>\n<li>Advanced cases may require <strong>radiation or chemotherapy.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old lady presented with a 1.5 cm pigmented lesion on her face that was growing rapidly in size and associated with itching. The lesion is shown below. Which of the following is likely the diagnosis?", "options": [{"label": "A", "text": "Dysplastic nevus", "correct": false}, {"label": "B", "text": "Congenital melanocytic nevus", "correct": false}, {"label": "C", "text": "Acquired melanocytic nevus", "correct": false}, {"label": "D", "text": "Malignant melanoma", "correct": true}], "correct_answer": "D. Malignant melanoma", "question_images": ["https://image.prepladder.com/content/iUhO3Jr4DTx72m5fVEjD1747024520.png"], "explanation_images": ["https://image.prepladder.com/content/9W4uO3VA9rmvjzxlmOht1747024806.png", "https://image.prepladder.com/content/ztxq7udSu14sJaRKtZ1N1747024833.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Malignant melanoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Melanoma is a <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumour arising from <strong>melanocytes at the epidermal-dermal junction.</strong> Though it is a rare skin cancer, it has a high mortality rate. It presents as a <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> that enlarges, ulcerates, or bleeds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive family history.</li>\n<li>Fair skin.</li>\n<li>Genetics: <strong>CDKN2A </strong>(chromosome <strong>9p21</strong>), MC1R, and TYR genes.</li>\n<li>Nevus:\n\t\t\t\t<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"f23fb27bcf169277719237a433653d\">melanocytic</span> nevi.</li>\n<li>Junctional nevi.</li>\n<li>Atypical nevi.</li>\n<li>Dysplastic nevi.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(P</strong>neumonic<strong>: ABCDE)</strong></p>\n<ul>\n<li>Asymmetry: <strong>Irregular shapes.</strong></li>\n<li>Border:<strong> Irregular. </strong></li>\n<li>Colour: <strong>Various colours present or uneven distribution.</strong></li>\n<li>Diameter: <strong>&gt; 6 mm</strong>.</li>\n<li>Evolution:<strong> Changes in <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> over time</strong> (size, shape, itching, or bleeding)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical examination.</li>\n<li>Dermoscopy.</li>\n<li>Biopsy.</li>\n<li>Immunohistochemistry: The markers are <strong>S-100, HMB-45</strong> (the most specific), <strong>Melan-A</strong> (MART-1), and <strong>MITF.</strong></li>\n<li>CT scan.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (with margins measured before <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and determined by Breslow depth, <span class=\"customMeta\" data-dictid=\"f08132bdfb16927771986a66c5d7b6\">sentinel</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> indicated for tumours with a depth of &gt;1.0 mm).</li>\n<li>If the tumour is aggressive:\n\t\t\t\t<ul>\n<li>Immunotherapy.</li>\n<li>Chemotherapy.</li>\n<li>Targeted therapy.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Interferon-𝛼</strong> is the only <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> treatment that has documented beneficial effects on overall survival.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common primary source of metastasis to the brain is:", "options": [{"label": "A", "text": "Thyroid", "correct": false}, {"label": "B", "text": "Lung", "correct": true}, {"label": "C", "text": "Liver", "correct": false}, {"label": "D", "text": "Breast", "correct": false}], "correct_answer": "B. Lung", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A factory worker working in a plastic pipe factory presented to the OPD with weight loss and right upper quadrant abdominal pain for 6 months duration. He had hepatomegaly. Further investigation revealed that most of the liver was replaced by a hemorrhagic tumour with extensive necrosis. What can be the likely diagnosis in this case?", "options": [{"label": "A", "text": "Cavernous hemangioma", "correct": false}, {"label": "B", "text": "Metastatic carcinoma of the liver", "correct": false}, {"label": "C", "text": "Angiosarcoma of the liver", "correct": true}, {"label": "D", "text": "Primary hepatocellular carcinoma", "correct": false}], "correct_answer": "C. Angiosarcoma of the liver", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hepatic Angiosarcoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is a <strong>high-grade <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> </strong>that arises from the endothelial cells lining blood vessels or <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</li>\n<li>It is the <strong>most common sarcoma</strong> arising in the liver, especially in those with significant exposure to <strong>Vinyl chloride.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Men and elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arsenic,</li>\n<li>Radiation,</li>\n<li>Thorium <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (Thorotrast)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It can spread through <strong>lymphatic and <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> routes</strong>, but due to the tumour's <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> nature, <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread (via blood vessels) is more common.</li>\n<li>The<strong> liver and lungs</strong> are common sites of metastasis, reflecting the tumour's aggressive nature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It presents as a <strong>red-brown, indurated, and ulcerated skin lesion. </strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most commonly seen tumour in the retroperitoneal space?", "options": [{"label": "A", "text": "Liposarcoma", "correct": true}, {"label": "B", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "C", "text": "Synovial sarcoma", "correct": false}, {"label": "D", "text": "Neurofibroma", "correct": false}], "correct_answer": "A. Liposarcoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely primary site of origin for metastatic liver adenocarcinoma with CK 7 (-), CK 20 (+), and CDX-1 (+) IHC markers?", "options": [{"label": "A", "text": "Colon carcinoma", "correct": true}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Pancreatic carcinoma", "correct": false}, {"label": "D", "text": "Ovarian carcinoma", "correct": false}], "correct_answer": "A. Colon carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CK7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CK20</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CDX1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colon cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Breast cancer (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic cancer (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ovarian cancer (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: A. Marjolin ulcer over the dorsum of foot measuring 3cm x 2cm 1. Excision biopsy B. 1.5 cm cervical lymph node in the neck 2. Core needle biopsy C. Soft tissue sarcoma over mid-thigh 3. USG guided FNAC D. Solitary thyroid nodule 4. Wedge biopsy", "options": [{"label": "A", "text": "A-1, B-2, C-3, D-4", "correct": false}, {"label": "B", "text": "A-4, B-1, C-2, D-3", "correct": true}, {"label": "C", "text": "A-3, B-2, C-1, D-4", "correct": false}, {"label": "D", "text": "A-4, B-3, C-2, D-1", "correct": false}], "correct_answer": "B. A-4, B-1, C-2, D-3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Marjolin <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> over the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of foot measuring 3cm x 2cm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wedge <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> </strong>(removing a small wedge-shaped tissue sample from the nodule) is commonly performed on a <span class=\"customMeta\" data-dictid=\"770ac6263216927771911afa24094b\">Marjolin ulcer</span> (a <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation in a chronic non-healing wound).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1.5 cm <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> in the neck </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Excision <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> </strong>is commonly used to evaluate a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Soft tissue <span class=\"customMeta\" data-dictid=\"82068425041692777198fe3064c370\">sarcoma</span> over mid-thigh </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Core needle <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> </strong>involves obtaining a small cylindrical core of tissue from the <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> for <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> examination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Solitary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> nodule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>USG guided FNAC </strong>is used to evaluate a <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> by guiding a needle into the tumour to collect cells for cytological analysis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the meaning of neoadjuvant chemotherapy in the context of a 54-year-old woman diagnosed with stage 2A cervical cancer?", "options": [{"label": "A", "text": "Chemotherapy is given along with radiation.", "correct": false}, {"label": "B", "text": "Chemotherapy is given during surgery.", "correct": false}, {"label": "C", "text": "Chemotherapy is given before radical surgery to reduce the bulk of the tumour.", "correct": true}, {"label": "D", "text": "Chemotherapy is given after radical surgery for micrometastases.", "correct": false}], "correct_answer": "C. Chemotherapy is given before radical surgery to reduce the bulk of the tumour.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a known case of HTN came in with complaints of headaches for five days. All classical signs, increased metanephrine levels, and other investigations indicate pheochromocytoma. What is the best imaging modality for this patient?", "options": [{"label": "A", "text": "CECT Chest and Abdomen", "correct": false}, {"label": "B", "text": "Sestamibi scan", "correct": false}, {"label": "C", "text": "MIBG", "correct": true}, {"label": "D", "text": "USG", "correct": false}], "correct_answer": "C. MIBG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - MIBG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with redness and a Peau d'orange appearance involving more than 2/3 of her breast, without any palpable lump in the breast. On further evaluation, it is found that the skin involvement extends to the chest wall and is suggestive of inflammatory carcinoma . What is the appropriate TNM staging for this patient?", "options": [{"label": "A", "text": "T4a", "correct": false}, {"label": "B", "text": "T4b", "correct": false}, {"label": "C", "text": "T3", "correct": false}, {"label": "D", "text": "T4d", "correct": true}], "correct_answer": "D. T4d", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D - T4d</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>T Category</strong></td>\n<td><strong>T Criteria</strong></td>\n</tr>\n<tr>\n<td>TX</td>\n<td>Primary tumor cannot be assessed</td>\n</tr>\n<tr>\n<td>T0</td>\n<td>No evidence of primary tumor</td>\n</tr>\n<tr>\n<td>Tis (DCIS)</td>\n<td>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ</td>\n</tr>\n<tr>\n<td>Tis (Paget)</td>\n<td>Paget disease not associated with <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or DCIS</td>\n</tr>\n<tr>\n<td>T1a</td>\n<td>Tumor size ≤1 mm</td>\n</tr>\n<tr>\n<td>T1b</td>\n<td>Tumor size &gt;1 mm but ≤5 mm</td>\n</tr>\n<tr>\n<td>T1c</td>\n<td>Tumor size &gt;5 mm but ≤10 mm</td>\n</tr>\n<tr>\n<td>T1d</td>\n<td>Tumor size &gt;10 mm but ≤20 mm</td>\n</tr>\n<tr>\n<td>T2</td>\n<td>Tumor size &gt;20 mm but ≤50 mm</td>\n</tr>\n<tr>\n<td>T3</td>\n<td>Tumor size &gt;50mm</td>\n</tr>\n<tr>\n<td>T4a</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> invasion</td>\n</tr>\n<tr>\n<td>T4b</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> skin changes including <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> and/or satellite skin nodules and/or edema</td>\n</tr>\n<tr>\n<td>T4c</td>\n<td>Tumor with criteria of both T4a and T4b</td>\n</tr>\n<tr>\n<td>T4d</td>\n<td>Inflammatory carcinoma</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>T Category</strong></td>\n<td><strong>T Criteria</strong></td>\n</tr>\n<tr>\n<td>TX</td>\n<td>Primary tumor cannot be assessed</td>\n</tr>\n<tr>\n<td>T0</td>\n<td>No evidence of primary tumor</td>\n</tr>\n<tr>\n<td>Tis (DCIS)</td>\n<td>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ</td>\n</tr>\n<tr>\n<td>Tis (Paget)</td>\n<td>Paget disease not associated with <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or DCIS</td>\n</tr>\n<tr>\n<td>T1a</td>\n<td>Tumor size ≤1 mm</td>\n</tr>\n<tr>\n<td>T1b</td>\n<td>Tumor size &gt;1 mm but ≤5 mm</td>\n</tr>\n<tr>\n<td>T1c</td>\n<td>Tumor size &gt;5 mm but ≤10 mm</td>\n</tr>\n<tr>\n<td>T1d</td>\n<td>Tumor size &gt;10 mm but ≤20 mm</td>\n</tr>\n<tr>\n<td>T2</td>\n<td>Tumor size &gt;20 mm but ≤50 mm</td>\n</tr>\n<tr>\n<td>T3</td>\n<td>Tumor size &gt;50mm</td>\n</tr>\n<tr>\n<td>T4a</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> invasion</td>\n</tr>\n<tr>\n<td>T4b</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> skin changes including <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> and/or satellite skin nodules and/or edema</td>\n</tr>\n<tr>\n<td>T4c</td>\n<td>Tumor with criteria of both T4a and T4b</td>\n</tr>\n<tr>\n<td>T4d</td>\n<td>Inflammatory carcinoma</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents with a non-palpable lump in the breast. The biopsy and IHC results reveal Luminal A. What characteristics are included under Luminal A?", "options": [{"label": "A", "text": "ER positive, PR positive, Her2 neu positive", "correct": false}, {"label": "B", "text": "ER positive, PR positive, Her2 neu negative with low proliferation", "correct": true}, {"label": "C", "text": "ER positive, PR positive, Her2 neu negative with high proliferation", "correct": false}, {"label": "D", "text": "Triple-negative", "correct": false}], "correct_answer": "B. ER positive, PR positive, Her2 neu negative with low proliferation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ER Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>PR Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HER2 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ki-67 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally, it is low grade, has a better prognosis, and is responsive to hormonal therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal B </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher grade, poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A, may require targeted HER2 therapy following status.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HER2-enriched</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aggressive, higher grade, poor prognosis, requires targeted HER2 therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basal-like</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Includes triple-negative breast cancer (TNBC), highly aggressive, no targeted hormonal therapy.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Claudin-low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often associated with poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and aggressive behaviour, typically lacks response to hormonal therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a follow-up case of prostate cancer, what do we need to check?", "options": [{"label": "A", "text": "Alkaline phosphatase", "correct": false}, {"label": "B", "text": "PSA", "correct": true}, {"label": "C", "text": "Testosterone", "correct": false}, {"label": "D", "text": "Acid phosphatase", "correct": false}], "correct_answer": "B. PSA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance in <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Cancer Follow-Up</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSA (Prostate-Specific Antigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most important marker; rising levels indicate <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (ALP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marker for <strong>bone metastases</strong>, but not routinely used for follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acid <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (PAP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older marker, now largely replaced by PSA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testosterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Checked in hormone-sensitive cases on ADT to confirm <strong>castrate levels</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spread of prostate cancer to lumbar vertebra is via?", "options": [{"label": "A", "text": "Arterial spread", "correct": false}, {"label": "B", "text": "Local spread", "correct": false}, {"label": "C", "text": "Lymphatic spread", "correct": false}, {"label": "D", "text": "Venous spread", "correct": true}], "correct_answer": "D. Venous spread", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism &amp; Common Sites</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct extension into the <strong>seminal vesicles, bladder, or rectum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obturator, internal &amp; external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> nodes</strong> are commonly involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematogenous spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Via <strong>Batson’s <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> → <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae, pelvis, femur, ribs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, usually occurs <strong>late</strong> in disease progression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the T stage for this tumour in the oral cavity?", "options": [{"label": "A", "text": "T3", "correct": false}, {"label": "B", "text": "T4a", "correct": true}, {"label": "C", "text": "T2", "correct": false}, {"label": "D", "text": "T4b", "correct": false}], "correct_answer": "B. T4a", "question_images": ["https://image.prepladder.com/content/OEi4HNe2CzHH6OjWh2Fq1741855826.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Staging of Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">Cavity</span> Cancer (AJCC 8th Edition):</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>T (Primary Tumor):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary tumor cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carcinoma in situ.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤2 cm, ≤5 mm depth of invasion (DOI).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤2 cm, DOI &gt;5 mm and ≤10 mm; or tumor &gt;2 cm but ≤4 cm, and ≤10 mm DOI. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt;4 cm; or any tumor &gt;10 mm DOI. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderately advanced local disease - Invades through <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bone, deep/ <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, maxillary sinus, or skin of the face.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very advanced local disease - Invades masticator space, <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates, skull base, or encases internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>N (Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, ≤3 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>N2a: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> node, &gt;3 cm but ≤6 cm in greatest dimension.</li>\n<li>N2b: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> nodes, all ≤6 cm).</li>\n<li>N2c: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, all ≤6 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>N3a: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> &gt;6 cm in greatest dimension, ENE(-).</li>\n<li>N3b: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in any node(s) with clinically overt ENE(+).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>M (Distant Metastasis):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage <span class=\"customMeta\" data-dictid=\"d5b9840ce01692777188803b4c75b4\">Grouping</span> of oral cancer </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1 N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2 N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3 N0 M0 or T1-3 N1 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a N0-1 M0 or T1-4a N2 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any T N3 M0 or T4b Any N M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any T Any N M1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is preferred for lowering uric acid to prevent renal damage in tumor lysis syndrome ?", "options": [{"label": "A", "text": "Furosemide", "correct": false}, {"label": "B", "text": "Rasburicase", "correct": true}, {"label": "C", "text": "Corticosteroids", "correct": false}, {"label": "D", "text": "Febuxostat", "correct": false}], "correct_answer": "B. Rasburicase", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What category of malignancy do rodent ulcers belong to?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": true}, {"label": "C", "text": "Malignant Melanoma", "correct": false}, {"label": "D", "text": "Adenocarcinoma", "correct": false}], "correct_answer": "B. Basal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cancers is the most common primary for brain metastasis ?", "options": [{"label": "A", "text": "Lung cancer", "correct": true}, {"label": "B", "text": "Head and neck cancer", "correct": false}, {"label": "C", "text": "Prostate cancer", "correct": false}, {"label": "D", "text": "Breast cancer", "correct": false}], "correct_answer": "A. Lung cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lung\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is not seen in tumor lysis syndrome ?", "options": [{"label": "A", "text": "Hypophosphatemia", "correct": true}, {"label": "B", "text": "Hypocalcemia", "correct": false}, {"label": "C", "text": "Hyperuricemia", "correct": false}, {"label": "D", "text": "Hyperkalemia", "correct": false}], "correct_answer": "A. Hypophosphatemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hypophosph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cock's peculiar tumor is:", "options": [{"label": "A", "text": "Papilloma", "correct": false}, {"label": "B", "text": "Infected sebaceous cyst of scalp", "correct": true}, {"label": "C", "text": "Cylindroma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "B. Infected sebaceous cyst of scalp", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F3PrEdZ2NRMcdWm9I2cN1714022567.png", "https://image.prepladder.com/content/2ypYCtp0OCw4wxo00R3T1714022589.png", "https://image.prepladder.com/content/YET1ObKySy8GphvVIw7Y1714022624.png", "https://image.prepladder.com/content/Scglx2KQRQxIZMSp9Wk31714022642.png"], "explanation": "<p>Correct Option B - Infected &lt;span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\"&gt;sebaceous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\"&gt;cyst&lt;/span&gt; of scalp: \n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cock’s peculiar tumor</strong></p>\n<ul>\n<li>Infected <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> of scalp</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/2ypYCtp0OCw4wxo00R3T1714022589.png\" style=\"height:225px; width:200px\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pott’s puffy tumor</strong></p>\n<ul>\n<li>Osteomyelitis of skull bones</li>\n<li>MC skull bone involved – <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">Frontal</span> bone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/YET1ObKySy8GphvVIw7Y1714022624.png\" style=\"height:207px; width:200px\"/><img src=\"https://image.prepladder.com/content/Scglx2KQRQxIZMSp9Wk31714022642.png\" style=\"height:186px; width:200px\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 35-year-old male sustained a head injury following a motorcycle accident. He experienced a brief loss of consciousness at the scene. Upon regaining consciousness, he developed a severe headache and began to feel drowsy. A CT scan of the head is performed. Which of the following should be the management for this patient?", "options": [{"label": "A", "text": "Anticoagulants", "correct": false}, {"label": "B", "text": "Immediate surgical decompression", "correct": true}, {"label": "C", "text": "Observation in ICU", "correct": false}, {"label": "D", "text": "Mannitol administration", "correct": false}], "correct_answer": "B. Immediate surgical decompression", "question_images": ["https://image.prepladder.com/content/meUEAfnIu1Xxtlto4Ub61717763410.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Immediate &lt;span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\"&gt;surgical&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not done in the primary survey of trauma?", "options": [{"label": "A", "text": "NCCT head", "correct": true}, {"label": "B", "text": "CXR", "correct": false}, {"label": "C", "text": "Intubation", "correct": false}, {"label": "D", "text": "ICD drainage", "correct": false}], "correct_answer": "A. NCCT head", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - NCCT h\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary survey</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adjuncts of primary survey</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Airway maintenance with <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine protection</li>\n<li>Breathing includes <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> and oxygenation</li>\n<li>Circulation with <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> control</li>\n<li>Disability (brief neurological examination)</li>\n<li>Exposure with environmental control</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oxygen</li>\n<li>Pulse oximetry</li>\n<li>BP monitoring</li>\n<li>ECG monitoring</li>\n<li>NG tube, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> insertion</li>\n<li>Ventilation rate</li>\n<li>ABG levels</li>\n<li>X-ray- Chest and pelvis</li>\n<li>FAST</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mount fuji sign on CT is seen in which of the following?", "options": [{"label": "A", "text": "Pneumocephalus", "correct": true}, {"label": "B", "text": "Pneumoperitoneum", "correct": false}, {"label": "C", "text": "Pneumomediastinum", "correct": false}, {"label": "D", "text": "Pneumothorax", "correct": false}], "correct_answer": "A. Pneumocephalus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZfLAyjR1ZzfEygByelCZ1717765489.png"], "explanation": "<p>Correct Option A - Pneumocephalu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a complicated delivery, a mother died. Which of the following is the most common Direct cause of maternal death?", "options": [{"label": "A", "text": "Embolism", "correct": false}, {"label": "B", "text": "Heart Disease", "correct": false}, {"label": "C", "text": "Hemorrhage", "correct": true}, {"label": "D", "text": "Anemia", "correct": false}], "correct_answer": "C. Hemorrhage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hDuopNovH6y4fliz71rW1697716177.png"], "explanation": "<p>Correct Option C - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which fluid is administered most commonly during intraoperative blood loss?", "options": [{"label": "A", "text": "Isolyte P", "correct": false}, {"label": "B", "text": "Crystalloids", "correct": true}, {"label": "C", "text": "Blood", "correct": false}, {"label": "D", "text": "Colloids", "correct": false}], "correct_answer": "B. Crystalloids", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - Crystalloids: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old female presented in the OPD with bloody discharge from the nipple . On examination, it was found to be from a single lactiferous duct . What is the treatment for bloody nipple discharge with single duct involvement?", "options": [{"label": "A", "text": "Microdochectomy", "correct": true}, {"label": "B", "text": "Hadfield’s procedure", "correct": false}, {"label": "C", "text": "Microdiscectomy", "correct": false}, {"label": "D", "text": "IV antibiotics + Incision", "correct": false}], "correct_answer": "A. Microdochectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Microdochectomy \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not correct for the device depicted below:", "options": [{"label": "A", "text": "Based on infrared emitted from RBCs", "correct": true}, {"label": "B", "text": "Localizes calcified plaque", "correct": false}, {"label": "C", "text": "Checks blood flow", "correct": false}, {"label": "D", "text": "Checks thickness of artery and vein", "correct": false}], "correct_answer": "A. Based on infrared emitted from RBCs", "question_images": ["https://image.prepladder.com/content/LFbrQCGdCk07eOQjnxhv1700119115.png"], "explanation_images": [], "explanation": "<p>Correct option A - Based on &lt;span class=\"customMeta\" data-dictid=\"82df9c600116927771907b7977a3b4\"&gt;infrared&lt;/span&gt; emitted from RBC\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a complication usually associated with the procedure shown in the image below?", "options": [{"label": "A", "text": "Aspiration", "correct": false}, {"label": "B", "text": "Torticollis", "correct": false}, {"label": "C", "text": "Pneumothorax", "correct": true}, {"label": "D", "text": "Recurrent laryngeal nerve paralysis", "correct": false}], "correct_answer": "C. Pneumothorax", "question_images": ["https://image.prepladder.com/content/JgkhYFOHv8VMSaf5bmKM1744979501.png"], "explanation_images": ["https://image.prepladder.com/content/L60h8avAfR45iq3cuIym1745931976.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ The tip is located in the superior vena cava.</li><li>↳ Order of preference: Subclavian vein &gt; Internal jugular vein &gt; Femoral vein</li><li>↳ Inside OT: Internal jugular vein</li><li>↳ Outside OT: Subclavian vein.</li><li>↳ Complications: Catheter-related sepsis, pneumothorax.</li><li>↳ Complications:</li><li>↳ pneumothorax.</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Aspiration (Option A) involves inhaling stomach contents or foreign material into the lungs. Although it can occur in various clinical situations, it is not typically associated with central line placement.</li><li>↳ Aspiration</li><li>↳ (Option A)</li><li>↳ Torticollis (Option B) , or wry neck, is a condition where the neck muscles involuntarily contract, causing the neck to twist to one side. This is not a complication directly related to central line placement.</li><li>↳ Torticollis</li><li>↳ (Option B)</li><li>↳ Recurrent laryngeal nerve paralysis (Option D) is a complication typically associated with surgeries or procedures involving the neck or chest, such as thyroid or thoracic surgery. It is not commonly linked to central line placement.</li><li>↳ Recurrent laryngeal nerve paralysis</li><li>↳ (Option D)</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the options provided, which one is NOT acknowledged as a potential complication resulting from a significant blood transfusion?", "options": [{"label": "A", "text": "Hypocalcemia", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": false}, {"label": "C", "text": "Hypothermia", "correct": false}, {"label": "D", "text": "Hypernatremia", "correct": true}], "correct_answer": "D. Hypernatremia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the minimum platelet count necessary for most surgical procedures?", "options": [{"label": "A", "text": "20,000 (10^9/L)", "correct": false}, {"label": "B", "text": "30,000 (10^9/L)", "correct": false}, {"label": "C", "text": "40,000 (10^9/L)", "correct": false}, {"label": "D", "text": "50,000 (10^9/L)", "correct": true}], "correct_answer": "D. 50,000 (10^9/L)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure being performed in the image given below.", "options": [{"label": "A", "text": "Intraosseous cannula for pain relief", "correct": false}, {"label": "B", "text": "Bone marrow aspiration", "correct": false}, {"label": "C", "text": "Intraosseous route access for giving IV fluids", "correct": true}, {"label": "D", "text": "Bone marrow biopsy", "correct": false}], "correct_answer": "C. Intraosseous route access for giving IV fluids", "question_images": ["https://image.prepladder.com/notes/aXK54PAFb85tXo8jnbxW1745916342.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the clinic with a lesion as shown in the image. He had a traumatic injury to the chest one year ago, and the scar has grown beyond the boundary of the initial injury. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hemangioma", "correct": false}, {"label": "B", "text": "Hypertrophic scar", "correct": false}, {"label": "C", "text": "Keloid", "correct": true}, {"label": "D", "text": "Neurofibroma", "correct": false}], "correct_answer": "C. Keloid", "question_images": ["https://image.prepladder.com/content/4Sp5WB5eVKPAXic42DxO1745299201.png"], "explanation_images": ["https://image.prepladder.com/content/VpKVKHRdOfJSENtowiyu1745299249.png", "https://image.prepladder.com/content/bhxi62PdXzQUDlqmCN7Y1745299249.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents with a 5-day fever history and signs of hypotension, tachycardia, tachypnea, and altered mental status. Lab results show elevated white blood cell count, neutrophil proportion, and serum creatinine. The intern doctor plans to assess the quick Sequential Organ Failure Assessment (qSOFA) score for prognosis prediction and hospitalisation duration. Which elements are part of the qSOFA score?", "options": [{"label": "A", "text": "BP, RR, and CBC", "correct": false}, {"label": "B", "text": "Creatinine, PR, and BP", "correct": false}, {"label": "C", "text": "RR, Body temperature, and PR", "correct": false}, {"label": "D", "text": "SBP, RR, and GCS score", "correct": true}], "correct_answer": "D. SBP, RR, and GCS score", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which class of hypovolemic shock, according to Advanced Trauma Life Support (ATLS) guidelines, is characterised by the absence of urine output?", "options": [{"label": "A", "text": "Class I", "correct": false}, {"label": "B", "text": "Class II", "correct": false}, {"label": "C", "text": "Class III", "correct": false}, {"label": "D", "text": "Class IV", "correct": true}], "correct_answer": "D. Class IV", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class I</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class II</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class III</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class IV </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood loss (%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-15%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15-30%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>30-40%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 40%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central Nervous System (CNS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slightly anxious</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mildly anxious</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anxious or confused</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused or lethargic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulse (beats/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 120</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 140</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulse pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory rate (breaths/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>14-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>30-40</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 35</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine output (mL/hr)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negligible/Nil</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid requirement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid + Blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid + Blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Base deficit (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0 to -2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-2 to -6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-6 to -10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-10 or less</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man was brought to the emergency department after sustaining an RTA and injury to the lower chest. On presentation, the patient is stable, and vitals are normal. Chest radiography showed clear lung fields. What is the next step in management?", "options": [{"label": "A", "text": "eFAST", "correct": true}, {"label": "B", "text": "Tube thoracostomy", "correct": false}, {"label": "C", "text": "CECT chest", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": false}], "correct_answer": "A. eFAST", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u3GKOBXLa24YZhCw805M1746167420.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the qSOFA score components?", "options": [{"label": "A", "text": "Respiratory rate &amp;gt;22", "correct": false}, {"label": "B", "text": "Lactate dehydrogenase", "correct": true}, {"label": "C", "text": "Altered mental status", "correct": false}, {"label": "D", "text": "Systolic blood pressure &amp;lt;100 mmHg", "correct": false}], "correct_answer": "B. Lactate dehydrogenase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the options provided, which pairing correctly matches the trauma patients brought to the casualty?", "options": [{"label": "A", "text": "Extradural hemorrhage (EDH) - Pin point pupil", "correct": false}, {"label": "B", "text": "Penetrating injury to eustachian tube - CSF otorrhea", "correct": false}, {"label": "C", "text": "Penetrating injury to eye - Battle sign", "correct": false}, {"label": "D", "text": "Gaze palsy - Mid brain lesion", "correct": true}], "correct_answer": "D. Gaze palsy - Mid brain lesion", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In all types of shock, which of the following is observed?", "options": [{"label": "A", "text": "Reduced tissue perfusion", "correct": true}, {"label": "B", "text": "Increased peripheral resistance", "correct": false}, {"label": "C", "text": "Decreased respiratory rate", "correct": false}, {"label": "D", "text": "Cold clammy skin", "correct": false}], "correct_answer": "A. Reduced tissue perfusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced circulating blood volume</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemorrhage, Dehydration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Failure of the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> pump</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myocardial Infarction, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Dysrhythmias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> filling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiac Tamponade, Tension Pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> leading to organ hypoperfusion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Septic Shock, Anaphylactic Shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endocrine Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Combination of hypovolemic, cardiogenic, or distributive shock mechanisms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Addisonian Crisis, <span class=\"customMeta\" data-dictid=\"a856fbe9fc1692777193631fa87f91\">Myxedema</span> Coma</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the purpose of preventing surgical site infection, what is the recommended technique and optimal timing for hair removal prior to surgery?", "options": [{"label": "A", "text": "On the OT table with electric hair clippers", "correct": true}, {"label": "B", "text": "With a razor 24 hours before surgery", "correct": false}, {"label": "C", "text": "With a hair removal cream on the previous day", "correct": false}, {"label": "D", "text": "On the OT table with a razor", "correct": false}], "correct_answer": "A. On the OT table with electric hair clippers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives at the emergency department after being involved in a car accident. The patient is experiencing difficulty breathing and their neck veins appear dilated. The x-ray reveals a significant amount of air on the left side. What is the most appropriate course of action for treatment?", "options": [{"label": "A", "text": "Wide bore needle insertion in the 5th intercostal space", "correct": true}, {"label": "B", "text": "Endotracheal intubation", "correct": false}, {"label": "C", "text": "Tracheostomy", "correct": false}, {"label": "D", "text": "Pericardiocentesis", "correct": false}], "correct_answer": "A. Wide bore needle insertion in the 5th intercostal space", "question_images": ["https://image.prepladder.com/content/DCmCbzUYHJw9yGjkxfiY1685075467.png"], "explanation_images": ["https://image.prepladder.com/content/CJ3oHw5Ti5a00zTi5zw61685075526.png"], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient sustained a crush injury on their right arm. He was taken to the hospital and on examination, his arm was pulseless, swollen, and dark red. What would be the best way to manage this case?", "options": [{"label": "A", "text": "Intraosseous administration of fluids", "correct": false}, {"label": "B", "text": "Acidification of urine", "correct": false}, {"label": "C", "text": "Fasciotomy", "correct": true}, {"label": "D", "text": "Hemodialysis", "correct": false}], "correct_answer": "C. Fasciotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?", "options": [{"label": "A", "text": "Cervical spine injury", "correct": false}, {"label": "B", "text": "Tension pneumothorax", "correct": true}, {"label": "C", "text": "Blunt cardiac injury", "correct": false}, {"label": "D", "text": "Laryngotracheal injury", "correct": false}], "correct_answer": "B. Tension pneumothorax", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/qfrvpGk9CHovo7hj8jOD1745336556.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediately life-threatening injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potentially life-threatening injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Airway obstruction</li>\n<li>Tension pneumothorax</li>\n<li>Pericardial tamponade</li>\n<li>Open pneumothorax</li>\n<li>Massive haemothorax</li>\n<li>Flail chest</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic injuries</li>\n<li>Tracheobronchial injuries</li>\n<li>Myocardial contusion</li>\n<li>Rupture of the diaphragm</li>\n<li>Oesophageal injuries</li>\n<li>Pulmonary contusion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellpadding=\"0\" cellspacing=\"0\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"vertical-align:top\">\n<p><strong>Tension Pneumothorax</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p>It is a life-threatening condition where air accumulates in the pleural <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> under pressure, causing <strong>lung collapse</strong> on the affected side, <strong>mediastinal shift</strong>, and severe <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p>• It occurs when air enters the pleural <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> through a <strong>\"one-way valve\"</strong> mechanism, leading to lung collapse and <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift towards the opposite side.</p>\n<p>• ↑Pleural pressure→ Opposite lung compression→ ↓venous return→ ↓cardiac output and potentially sudden death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p>• Penetrating chest trauma.</p>\n<p>• Blunt chest trauma with parenchymal lung injury.</p>\n<p>• Iatrogenic lung injury (e.g., central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> catheterisation), and mechanical positive-pressure ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p>• Restlessness, tachypnea, dyspnea, tachycardia, and chest pain.</p>\n<p><strong>• Distended neck veins, hyper-resonance, and decreased or absent breath sound on the affected side.</strong></p>\n<p>• Late findings may include <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> and cyanosis.</p>\n<p>• Hypotension and severe mediastinal/tracheal shift are also common.</p>\n<figure class=\"caption_element\"><img alt=\"Tension pneumothorac\" data-author=\"Finlayson, Gordon N., Albert Chiang, Jay B Brodsky and Walter Bradford Cannon. “Intraoperative contralateral tension pneumothorax during pneumonectomy.” Anesthesia and analgesia 106 1 (2008): 58-60, table of contents .\" data-hash=\"11023\" data-license=\"OPEN ACCESS\" data-source=\"https://journals.lww.com/anesthesia-analgesia/fulltext/2008/01000/intraoperative_contralateral_tension_pneumothorax.9.aspx\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/qfrvpGk9CHovo7hj8jOD1745336556.jpg\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>• Needle Thoracocentesis:</strong> Immediate <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> with a large-bore needle in the 2nd <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space at the midclavicular line, or the \"safe triangle\". </p>\n<p>• Followed by <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> chest tube (ICT) placement in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary line.</p>\n<p>• Provide oxygen, analgesics, antibiotics, and <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> support if necessary.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hand rub can be utilised in accordance with the standard hand hygiene protocol in all locations listed below, with the exception of:", "options": [{"label": "A", "text": "If the hands are visibly soiled", "correct": true}, {"label": "B", "text": "While moving from a contaminated site to a clean site during patient care", "correct": false}, {"label": "C", "text": "After removing sterile gloves", "correct": false}, {"label": "D", "text": "During direct patient contact", "correct": false}], "correct_answer": "A. If the hands are visibly soiled", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Prv6Y4bAqgkABJyvf2ZQ1746704186.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a patient arriving at the emergency department with a road traffic accident (RTA), what is the appropriate order of steps in their management? Cervial spine stabilisation Intubation IV cannulation CECT", "options": [{"label": "A", "text": "1, 3, 2, 4", "correct": false}, {"label": "B", "text": "1, 2, 3, 4", "correct": true}, {"label": "C", "text": "2, 1, 3, 4", "correct": false}, {"label": "D", "text": "2, 1, 4, 3", "correct": false}], "correct_answer": "B. 1, 2, 3, 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the number (14Fr) marked on the Foley catheter correspond to?", "options": [{"label": "A", "text": "Inner lumen diameter", "correct": false}, {"label": "B", "text": "Length of the tube", "correct": false}, {"label": "C", "text": "Outer tube diameter", "correct": true}, {"label": "D", "text": "Bulb size", "correct": false}], "correct_answer": "C. Outer tube diameter", "question_images": ["https://image.prepladder.com/notes/LlmFFoLXBeJcZF9844gZ1745336558.jpg"], "explanation_images": ["https://image.prepladder.com/notes/cd6oaXKgLvNB4gm46fTp1745337176.jpg", "https://image.prepladder.com/notes/JQEycxKKNRknhDk9xCKP1745336559.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Material</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LATEX - </strong>Less <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> &amp; <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> formation</p>\n<p><strong>Silicone Coating-</strong> for Prolonged use (up to 3 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2-way Foley catheter</li>\n<li>3-way Foley catheter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Channels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2-way Foley catheter:</strong></p>\n<ul>\n<li>Main channel: For <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of urine</li>\n<li>Small channel: For inflating balloon</li>\n</ul>\n<p><strong>3-way Foley catheter:</strong></p>\n<ul>\n<li>Main channel: for <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of urine</li>\n<li>Additional channel for irrigation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Balloon Inflation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>20-30 ml <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for self-retaining</li>\n<li>30-50 ml of <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for a <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> effect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Sizes (French scale)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pediatric patients</strong>: 4, 6, 8, 10</p>\n<p><strong>Adult patients: </strong>12, 14, 16, 18</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Size Calculation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outer <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> in mm = Fr/3 (Fr - French units)</p>\n<p>E.g., if the size of the <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> is 18 French, then <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> = 18/3 = 6mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To relieve <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention</li>\n<li>To measure <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n<li>For administration of <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> chemotherapy</li>\n<li>3 ways <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> - for <span class=\"customMeta\" data-dictid=\"ea6a429a6b1692777190801502ba55\">Irrigation</span> after TURP</li>\n<li>May be used for supra-pubic cystostomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options does not represent one of the boundaries of the triangle of safety for the insertion of an ICD in a patient with a chest x-ray showing pneumothorax?", "options": [{"label": "A", "text": "Lateral edge of the pectoralis major", "correct": false}, {"label": "B", "text": "Mid-clavicular line", "correct": true}, {"label": "C", "text": "5th intercostal space", "correct": false}, {"label": "D", "text": "Lateral border of latissimus dorsi", "correct": false}], "correct_answer": "B. Mid-clavicular line", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4l2ozJx7Y7AkXbiKTUKz1745336560.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is accurate concerning split-thickness and full-thickness skin grafts? Primary contractures are more in split skin grafts Secondary contractures are more in split skin grafts Primary contractures are more in full-thickness grafts Secondary contractures are more in full-thickness grafts", "options": [{"label": "A", "text": "2 and 3", "correct": true}, {"label": "B", "text": "2 and 4", "correct": false}, {"label": "C", "text": "1 and 3", "correct": false}, {"label": "D", "text": "1 and 4", "correct": false}], "correct_answer": "A. 2 and 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Split-Thickness Skin Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Full-Thickness Skin Graft</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidermis + part of dermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidermis + full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large grafts can be taken</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only small grafts can be taken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft Survival</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Easier</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More difficult</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Donor Site Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heals spontaneously, allowing repeated grafts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> develops, preventing repeated grafts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">Contraction</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> is more significant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> is more significant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Donor Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inner thigh, upper arm, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> aspect of forearm, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper eyelid, retro <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> skin, <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> skin, <span class=\"customMeta\" data-dictid=\"116f4dd59e169277718172685cecb2\">antecubital</span> skin, <span class=\"customMeta\" data-dictid=\"5f4a18606116927771909db4d0fe2f\">inframammary</span> skin, inguinal skin, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> skin, <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Donor Site Exclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axilla is not used as a donor site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages of Harvesting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"b24aa5ceb516927771836a4cb7dd29\">calibration</span> of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> and large area coverage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calibration of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> for small but thick grafts</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true regarding central venous access and peripheral venous access? Phlebitis is the most common complication in peripheral venous access. Isotonic saline and heparin are flushed to retain patency If an arteriovenous fistula is present in a limb, avoid peripheral venous access in the same limb. Vasopressors for septic shock are given in the central line to avoid limb ischemia.", "options": [{"label": "A", "text": "1, 3, 4", "correct": false}, {"label": "B", "text": "2, 3, 4", "correct": false}, {"label": "C", "text": "1, 2, 3, 4", "correct": true}, {"label": "D", "text": "1, 2, 3", "correct": false}], "correct_answer": "C. 1, 2, 3, 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the options listed below does not belong to the category of damage control surgery?", "options": [{"label": "A", "text": "Control of hemorrhage", "correct": false}, {"label": "B", "text": "Resuscitation", "correct": false}, {"label": "C", "text": "Decontamination", "correct": false}, {"label": "D", "text": "Vascular anastomosis", "correct": true}], "correct_answer": "D. Vascular anastomosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phases of Damage Control Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognition and Decision-making</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intubation, early rewarming, and prompt movement to operation theatre</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate Laparotomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Control of bleeding, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> packing, and temporary <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> closure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intensive Care Unit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ongoing <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> and normalisation of <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> and biochemical parameters</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Re-Exploration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive repair of all injuries</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages of Damage Control Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intervention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient Selection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Control of haemorrhage and <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> <strong>(Option A, C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resuscitation in <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive Surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdomen closure</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding shock?", "options": [{"label": "A", "text": "Anaerobic respiration produces carbon dioxide", "correct": false}, {"label": "B", "text": "Hypovolaemic shock—most common type", "correct": true}, {"label": "C", "text": "Stage of compensatory shock is also called stage 2 of shock", "correct": false}, {"label": "D", "text": "Anaphylactic shock—is due to a Type 2 hypersensitivity reaction", "correct": false}], "correct_answer": "B. Hypovolaemic shock—most common type", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class I (Compensated Shock)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class II (Hypoxemia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IV (Refractory Shock)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 15%<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40%<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 40%<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compensatory mechanisms maintain <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalised vasoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decompensated shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;100/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-120/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>120-140/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;140/min</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-15 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mental Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert, normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anxious, mildly agitated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused, altered mental status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comatose, lethargic</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypovolemic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced circulating blood volume</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemorrhage, Dehydration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiogenic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Failure of the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> pump</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myocardial Infarction, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Dysrhythmias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> filling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac Tamponade, Tension Pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distributive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> leading to organ hypoperfusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Septic Shock, Anaphylactic Shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination of hypovolemic, cardiogenic, or distributive shock mechanisms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Addisonian Crisis, <span class=\"customMeta\" data-dictid=\"a856fbe9fc1692777193631fa87f91\">Myxedema</span> Coma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with multiple stab injuries to the chest. On examination, there is reduced chest movement on the right side and tracheal deviation to the left side. Additionally, the neck veins are distended. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Resuscitative thoracotomy", "correct": false}, {"label": "B", "text": "ICD placement", "correct": false}, {"label": "C", "text": "Needle thoracocentesis", "correct": true}, {"label": "D", "text": "Finger thoracotomy", "correct": false}], "correct_answer": "C. Needle thoracocentesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eUavJtAUOfi0uyYcUNvk1745308526.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tension Pneumothorax</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a life-threatening condition where air accumulates in the pleural <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> under pressure, causing<strong> </strong><strong>lung collapse</strong><strong> </strong>on the affected side, <strong>mediastinal shift</strong>, and severe <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It occurs when air enters the pleural <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> through a <strong>\"one-way valve\"</strong> mechanism, leading to lung collapse and <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift towards the opposite side.</li>\n<li>↑Pleural pressure→ Opposite lung compression→ ↓venous return→ ↓cardiac output and potentially sudden death.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Penetrating chest trauma.</li>\n<li>Blunt chest trauma with parenchymal lung injury.</li>\n<li>Iatrogenic lung injury (e.g., central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> catheterisation) and mechanical positive-pressure ventilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Restlessness, tachypnea, dyspnea, tachycardia, and chest pain.</li>\n<li><strong>Distended neck veins, hyper-resonance, and decreased or absent breath sound on the affected side.</strong></li>\n<li>Late findings may include <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> and cyanosis.</li>\n<li>Hypotension and severe mediastinal/tracheal shift are also common.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Needle Thoracocentesis</strong>: Immediate <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> with a large-bore needle in the 2nd <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space at the midclavicular line, or the \"safe triangle\".</li>\n<li>Followed by <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> chest tube (ICT) placement in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary line.</li>\n<li>Provide oxygen, analgesics, antibiotics, and <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> support if necessary.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"IM607\" data-author=\"Finlayson, Gordon N., Albert Chiang, Jay B Brodsky and Walter Bradford Cannon. “Intraoperative contralateral tension pneumothorax during pneumonectomy.” Anesthesia and analgesia 106 1 (2008): 58-60, table of contents .\" data-hash=\"10908\" data-license=\"OPEN ACCESS\" data-source=\"https://journals.lww.com/anesthesia-analgesia/fulltext/2008/01000/intraoperative_contralateral_tension_pneumothorax.9.aspx\" data-tags=\"April2025\" height=\"236\" src=\"https://image.prepladder.com/notes/eUavJtAUOfi0uyYcUNvk1745308526.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What steps should be taken to manage the case of a 24-year-old male who was hit by a motorbike while crossing the road, leading to abdominal injuries and bruising, with a blood pressure of 88/60 and IV fluids already administered, along with a positive FAST examination?", "options": [{"label": "A", "text": "Abdominal CT scan", "correct": false}, {"label": "B", "text": "Abdominal MRI scan", "correct": false}, {"label": "C", "text": "Exploratory laparotomy", "correct": true}, {"label": "D", "text": "Diagnostic peritoneal lavage", "correct": false}], "correct_answer": "C. Exploratory laparotomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with liver cirrhosis, what is the primary cause of mortality when esophageal varices are present?", "options": [{"label": "A", "text": "Hypovolemic shock", "correct": true}, {"label": "B", "text": "Cardiogenic shock", "correct": false}, {"label": "C", "text": "Obstructive shock", "correct": false}, {"label": "D", "text": "Distributive shock", "correct": false}], "correct_answer": "A. Hypovolemic shock", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Hypovolemic shock\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the size of the cannula gauge used in this picture?", "options": [{"label": "A", "text": "14", "correct": false}, {"label": "B", "text": "16", "correct": false}, {"label": "C", "text": "18", "correct": true}, {"label": "D", "text": "20", "correct": false}], "correct_answer": "C. 18", "question_images": ["https://image.prepladder.com/notes/czav1ECOo3aBsBgb0b7z1746444344.png"], "explanation_images": ["https://image.prepladder.com/notes/OpZeMnKHLtq12dq7UzZJ1746444502.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:749px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cannula <span class=\"customMeta\" data-dictid=\"7991fb415f16927771887b76483a71\">Gauge</span> (G)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outer Diameter (mm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow Rate (mL/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>14G</strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.1 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>240 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Massive transfusion, trauma, rapid fluid resuscitation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>16G</strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.8 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grey</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>180 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Major surgery, large fluid replacement, blood transfusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18G </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.3 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Green</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90-105 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Routine blood transfusion, IV fluids, medications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>20G</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.1 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pink</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>55-65 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV fluids, antibiotics, minor procedures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>22G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.9 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>33-36 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV medications, <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> &amp; elderly patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>24G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.7 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-22 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neonates, small veins, slow infusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>26G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.6 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purple</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13-15 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely used, for neonates &amp; fragile veins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old male patient was brought to the emergency department following a road traffic accident. His heart rate was 100/min, respiratory rate was 24/min, and his chest X ray is given below. Which of the following is contraindicated in him?", "options": [{"label": "A", "text": "Nasogastric tube insertion", "correct": false}, {"label": "B", "text": "Chest tube insertion", "correct": true}, {"label": "C", "text": "Log roll", "correct": false}, {"label": "D", "text": "Epidural anaesthesia", "correct": false}], "correct_answer": "B. Chest tube insertion", "question_images": ["https://image.prepladder.com/notes/yWqJpaMLFL4i8vV9NZFA1747112784.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was received in the casualty following a road traffic accident. His BP was 90/60 mmHg and his pulse rate was 120/min. The emergency room physician asked you to replace the fluid loss in this patient. What is the flow rate of fluid with the IV cannula given in the image?", "options": [{"label": "A", "text": "86ml/min", "correct": false}, {"label": "B", "text": "96ml/min", "correct": false}, {"label": "C", "text": "90 ml/min", "correct": true}, {"label": "D", "text": "63ml/min", "correct": false}], "correct_answer": "C. 90 ml/min", "question_images": ["https://image.prepladder.com/notes/czav1ECOo3aBsBgb0b7z1746444344.png"], "explanation_images": ["https://image.prepladder.com/notes/OpZeMnKHLtq12dq7UzZJ1746444502.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:749px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cannula Gauge (G)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outer Diameter (mm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow Rate (mL/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>14G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.1 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>240 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Massive transfusion, trauma, rapid fluid resuscitation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>16G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.8 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grey</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>180 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Major surgery, large fluid replacement, blood transfusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18G </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.3 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Green</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90-105 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Routine blood transfusion, IV fluids, medications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>20G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.1 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pink</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>55-65 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV fluids, antibiotics, minor procedures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>22G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.9 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>33-36 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV medications, <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> &amp; elderly patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>24G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.7 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-22 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neonates, small veins, slow infusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>26G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.6 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purple</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13-15 mL/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely used, for neonates &amp; fragile veins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient undergoes a mastectomy for breast cancer. Post-operatively, the surgeon decides to use a closed suction drain. Which of the following drain types is shown in the image below?", "options": [{"label": "A", "text": "Penrose drain", "correct": false}, {"label": "B", "text": "Jackson Pratt drain", "correct": true}, {"label": "C", "text": "Romovac suction drain", "correct": false}, {"label": "D", "text": "Hemovac drain", "correct": false}], "correct_answer": "B. Jackson Pratt drain", "question_images": ["https://image.prepladder.com/notes/iGRmx3585xIxqiZvJX8U1746446237.png"], "explanation_images": ["https://image.prepladder.com/notes/iGRmx3585xIxqiZvJX8U1746446237.png", "https://image.prepladder.com/notes/vVsE5torJ9rCViV0Cr6o1746446579.png", "https://image.prepladder.com/notes/iGRmx3585xIxqiZvJX8U1746446237.png", "https://image.prepladder.com/notes/V0rSYB6CImBTQwl4S7Kv1746446627.png", "https://image.prepladder.com/notes/LVPh4nMDkl1ONbgheMcD1746446659.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Penrose drain </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is an open, <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> drain consisting of a soft rubber tube. It relies on gravity and <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> action for drainage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Surgery\" data-author=\"Belzunegui T, Louis CJ, Torrededia L, Oteiza J \" data-hash=\"12010\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Penrose_drain#/media/File:Compartment_syndrome_in_the_hand_Intraoperative_image_of_the_dorsal_region_of_the_right_hand.png\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/vVsE5torJ9rCViV0Cr6o1746446579.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jackson-pratt drain </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consists of a soft, flattened <span class=\"customMeta\" data-dictid=\"a4609c06fd16927771983dad60e1a3\">silicone</span> tube connected to a soft plastic bulb</p>\n<p>The bulb can be compressed to create negative pressure</p>\n<p>Suitable for various surgeries, including breast, plastic, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> procedures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Surgery\" data-author=\"NA\" data-hash=\"12004\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/iGRmx3585xIxqiZvJX8U1746446237.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Romovac <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> drain </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Another type of closed <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> drain</p>\n<p>Uses a spring-loaded mechanism to create constant negative pressure</p>\n<p>Often used in <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> surgeries and joint replacements</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Surgery\" data-author=\"Sahay, Shailesh &amp; Kesarwani, Pawan &amp; Sharma, G. &amp; Tiwari, A..\" data-hash=\"12011\" data-license=\"CC BY-NC SA 4.0\" data-source=\"https://www.researchgate.net/figure/Picture-of-suction-drain-set-Its-metallic-trocar-was-used-to-create-the-shunt-Figure-2_fig1_376971997\" data-tags=\"May2025\" height=\"431\" src=\"https://image.prepladder.com/notes/V0rSYB6CImBTQwl4S7Kv1746446627.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemovac drain </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is another brand of closed <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> drain, similar in principle to the JP drain. However, Hemovac drains typically have a larger, more rigid collection chamber compared to the soft, compressible bulb of the JP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Surgery\" data-author=\"NA\" data-hash=\"12012\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/LVPh4nMDkl1ONbgheMcD1746446659.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is triage for?", "options": [{"label": "A", "text": "To prepare for a disaster", "correct": false}, {"label": "B", "text": "To assess the impact of a disaster", "correct": false}, {"label": "C", "text": "To classify the priority of treatment", "correct": true}, {"label": "D", "text": "To rehabilitate following a disaster", "correct": false}], "correct_answer": "C. To classify the priority of treatment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) To classify th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the instrument depicted below, which is utilized for the creation of a pneumoperitoneum?", "options": [{"label": "A", "text": "Veress needle", "correct": true}, {"label": "B", "text": "Morris' needle", "correct": false}, {"label": "C", "text": "Yankauer suction tip", "correct": false}, {"label": "D", "text": "Von Graefe needle", "correct": false}], "correct_answer": "A. Veress needle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) V\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the needle placement angle when using the interrupted suturing technique to suture a laceration in the ER?", "options": [{"label": "A", "text": "60 degrees", "correct": false}, {"label": "B", "text": "70 degrees", "correct": false}, {"label": "C", "text": "80 degrees", "correct": false}, {"label": "D", "text": "90 degrees", "correct": true}], "correct_answer": "D. 90 degrees", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) 90 deg\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Suture Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Knot Used</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interrupted Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Individual stitches, each tied off separately.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tied like standard knots.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Continuous Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single length of <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> for multiple stitches.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aberdeen <span class=\"customMeta\" data-dictid=\"98a26a969a169277719066f5ac85ea\">knot</span> at the end. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mattress Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used to <span class=\"customMeta\" data-dictid=\"69dbb476ab16927771872c0d9e30c1\">evert</span> or invert wound edges. Tied like <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> sutures.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tied like standard knots.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subcuticular Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placed under the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> for a <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> result, using <span class=\"customMeta\" data-dictid=\"330e2bf7d216927771804326d05181\">absorbable</span> sutures if needed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Buried knot.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What might you suspect as the diagnosis for a 26-year-old male patient who arrives at the emergency department complaining of abdominal pain and constipation persisting for the last three days? The patient recalls being struck in the abdomen by a bull three days ago. Could you examine the provided X-ray to aid in your assessment?", "options": [{"label": "A", "text": "Hemothorax", "correct": false}, {"label": "B", "text": "Hollow viscus perforation", "correct": true}, {"label": "C", "text": "Pneumothorax", "correct": false}, {"label": "D", "text": "Intestinal obstruction", "correct": false}], "correct_answer": "B. Hollow viscus perforation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) &lt;span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\"&gt;Hollow&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\"&gt;viscus&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following methods is accurate for measuring the nasogastric tube?", "options": [{"label": "A", "text": "Tip of nose to ear lobule to xiphisternum", "correct": true}, {"label": "B", "text": "Angle of mouth to tragus to xiphisternum", "correct": false}, {"label": "C", "text": "Ala of nose to angle of mandible to xiphisternum", "correct": false}, {"label": "D", "text": "Angle of mouth to ear lobule to umbilicus", "correct": false}], "correct_answer": "A. Tip of nose to ear lobule to xiphisternum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mLfymYFXz2HYX83rBSFR1745560105.png"], "explanation": "<p>Correct Option A - Tip of nose to ear &lt;span class=\"customMeta\" data-dictid=\"633bbec0f916927771913a073bbea5\"&gt;lobule&lt;/span&gt; to xiphisternu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 25-year-old patient who has been experiencing abdominal pain and fever for the past three days, based on the provided chest X-ray taken in an upright position?", "options": [{"label": "A", "text": "Hollow viscus perforation", "correct": true}, {"label": "B", "text": "Gastric volvulus", "correct": false}, {"label": "C", "text": "Liver abscess", "correct": false}, {"label": "D", "text": "Empyema thoracis", "correct": false}], "correct_answer": "A. Hollow viscus perforation", "question_images": ["https://image.prepladder.com/content/DdPZGGoCRjMfdvhTrAF81745472895.png"], "explanation_images": ["https://image.prepladder.com/content/FxihSQnKDyDteeiKnzv61745472932.png", "https://image.prepladder.com/notes/eS3KhE2TrjtWFtydKgXZ1746450182.png", "https://image.prepladder.com/notes/zeS1uPPFzXGFfycYfk8z1746450207.png", "https://image.prepladder.com/content/2hudY648gbIdKlTMLA321745472932.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient following a road traffic accident presented with subcutaneous emphysema. On auscultation, there was no air entry on the right side. Vitals were unstable. What will be your immediate management?", "options": [{"label": "A", "text": "Insertion of wide bore needle in the 2nd intercostal space", "correct": true}, {"label": "B", "text": "Wide bore needle decompression and IV fluids", "correct": false}, {"label": "C", "text": "Intubation and positive pressure ventilation", "correct": false}, {"label": "D", "text": "e-FAST", "correct": false}], "correct_answer": "A. Insertion of wide bore needle in the 2nd intercostal space", "question_images": ["https://image.prepladder.com/content/eEWziwvOucJMqFFRjwnJ1745476511.png"], "explanation_images": ["https://image.prepladder.com/content/um79fpU2bcRgJR0mq4pb1745476540.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, after a road traffic accident, presented with pain in the abdomen. The resident examined the child and found that vitals were stable, and tenderness was present in the left lumbar region. Which is the best investigation of choice?", "options": [{"label": "A", "text": "Contrast-enhanced CT scan", "correct": true}, {"label": "B", "text": "Retrograde urethrogram", "correct": false}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "Emergency laparotomy", "correct": false}], "correct_answer": "A. Contrast-enhanced CT scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The position of the patient in the image shown below is known as:", "options": [{"label": "A", "text": "Lloyd Davis position", "correct": false}, {"label": "B", "text": "Jack knife position", "correct": false}, {"label": "C", "text": "Trendelenburg position", "correct": false}, {"label": "D", "text": "Reverse Trendelenburg position", "correct": true}], "correct_answer": "D. Reverse Trendelenburg position", "question_images": ["https://image.prepladder.com/content/vyOzqBfygEhjXltvCemP1745578743.png"], "explanation_images": ["https://image.prepladder.com/content/ZXnm3woNpgj9eGVuIxKN1745578801.png", "https://image.prepladder.com/content/za9fkIcg0WDADHYTPSVD1745578801.png", "https://image.prepladder.com/content/Bgk4xSsklTNb8s2O6wax1745578801.png", "https://image.prepladder.com/content/URKPjrSZpOFWfweSl1851745578801.png", "https://image.prepladder.com/content/O3OfY19r0cMh2VFRFWAP1745578801.png", "https://image.prepladder.com/content/zOVqAps1j2GqibnproOj1745578801.png", "https://image.prepladder.com/content/9IVjYnwqvyIkBxAAzK2z1745578801.png", "https://image.prepladder.com/content/StbpU4mzBoaqNv3bAYFP1745578801.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Positioning on the Operating Table</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Uses and Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Supine Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Most common position for general <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures.</p>\n<p><u>Modifications of Supine position:</u></p>\n<ul>\n<li>Rose’s position</li>\n<li>Shoulder and Arm Extended</li>\n<li>Trendelenburg Position</li>\n<li>Reverse Trendelenburg Position</li>\n<li>Fowler's Position</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>General surgeries.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Rose's Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Supine with slight neck extension.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Head and neck surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Shoulder and Arm Extended</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Supine with shoulder and arm extended.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Axillary and breast surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Trendelenburg Position</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Head end tilted down, knees slightly flexed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pelvic procedures, resuscitating patients in shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Reverse Trendelenburg Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The head end tilted upward, placing the head higher than the feet.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries.</p>\n<p><strong>Complication: </strong>Right shoulder pain due to CO2 collected under the right <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> during <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fowler's Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Semi-sitting with the trunk raised at 40° and knees bent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neurosurgery, shoulder surgeries, patients with heart or <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure.</p>\n<p><strong>Complication: </strong>Increased risk of air embolism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Prone Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The patient is intubated and log-rolled onto the operating bed with help.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Spinal surgery, extra <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> abdominoperineal <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for rectal cancer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Jackknife Position</strong></p>\n<p><strong>(Option B)</strong></p>\n<p>(Prone Position Modification)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Chest supported, <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> relaxed by flexing at the hips.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Provides excellent access to the perineum.</p>\n<p><strong>Complication: </strong>Positional asphyxia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Lateral Decubitus or Kidney Position </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lower leg flexed, pillow between legs, upper leg flexed in an exaggerated position.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Draining abscesses, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> thoracotomy, urological and <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> procedures.</p>\n<p><strong>Complication:</strong> Increased risk of <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> injury due to hyperextension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Lithotomy Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Supine with hips and knees flexed, legs in stirrups, hips flexed to 90°.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Gynecological, perineal, and urological procedures.</p>\n<p><strong>Complication: </strong>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve injury if legs are not supported properly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Lloyd-Davies Position</strong></p>\n<p><strong>(Option A)</strong></p>\n<p>(Lithotomy Modification)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Supine with hips minimally flexed (~15°) and a 30° head-down tilt.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Gynecological, perineal, and urological procedures.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trendelenburg Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Glynda Rees Doyle and Jodie Anita McCutcheon \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Trendelenburg_position#/media/File:Trendelenburg_position.jpg\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/content/ZXnm3woNpgj9eGVuIxKN1745578801.png\" width=\"442\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reverse Trendelenburg Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Saltanat ebli \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://en.wikipedia.org/wiki/Trendelenburg_position#/media/File:Reverse_trendelenburg_position_01.gif\" data-tags=\"\" height=\"209\" src=\"https://image.prepladder.com/content/za9fkIcg0WDADHYTPSVD1745578801.png\" width=\"345\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fowler's Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Glynda Rees Doyle and Jodie Anita McCutcheon \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Fowler%27s_position#/media/File:Fowler's_Position.jpg\" data-tags=\"\" height=\"320\" src=\"https://image.prepladder.com/content/Bgk4xSsklTNb8s2O6wax1745578801.png\" width=\"554\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prone Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sascha Halvachizadeh Kai Oliver Jensen Hans Christoph Pape\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Prone-position-This-position-is-more-complex-because-it-requires-more-personnel-and_fig2_335584367\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/URKPjrSZpOFWfweSl1851745578801.png\" width=\"556\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jackknife Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ángela María Salazar Maya 1 ,* and Sandra Patrícia Osorio Galeano 2\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152920/\" data-tags=\"\" height=\"316\" src=\"https://image.prepladder.com/content/O3OfY19r0cMh2VFRFWAP1745578801.png\" width=\"556\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"f518295be51692777185698bd9b0fd\">decubitus</span> or Kidney Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ángela María Salazar Maya 1 ,* and Sandra Patrícia Osorio Galeano 2\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152920/\" data-tags=\"\" height=\"254\" src=\"https://image.prepladder.com/content/zOVqAps1j2GqibnproOj1745578801.png\" width=\"556\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lithotomy Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Saltanat ebli\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Lithotomy_position#/media/File:Lithotomy_position.jpg\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/9IVjYnwqvyIkBxAAzK2z1745578801.png\" width=\"555\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lloyd-Davies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Saltanat ebli\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://en.wikipedia.org/wiki/Lloyd-Davies_position#/media/File:Lloyd-Davies_position_01.jpg\" data-tags=\"\" height=\"368\" src=\"https://image.prepladder.com/content/StbpU4mzBoaqNv3bAYFP1745578801.png\" width=\"555\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "FAST stands for", "options": [{"label": "A", "text": "First assessment with sonography in trauma", "correct": false}, {"label": "B", "text": "Focussed assessment with sonography in trauma", "correct": true}, {"label": "C", "text": "First abdominal sonography in trauma", "correct": false}, {"label": "D", "text": "Focussed abdominal sonography in trauma", "correct": false}], "correct_answer": "B. Focussed assessment with sonography in trauma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the size of the cannula shown in the below image?", "options": [{"label": "A", "text": "16 G", "correct": false}, {"label": "B", "text": "18 G", "correct": false}, {"label": "C", "text": "20 G", "correct": true}, {"label": "D", "text": "22 G", "correct": false}], "correct_answer": "C. 20 G", "question_images": ["https://image.prepladder.com/notes/gmPf2657GbEpgSo3Dvcp1746525198.png"], "explanation_images": ["https://image.prepladder.com/content/InPGNRnakgvzpiDnG9xZ1745479710.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour code</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gauge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Flow rate (ml/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Orange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>14</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>240</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures and trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grey </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>180</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures and trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Green</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In Trauma and quick blood transfusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pink</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In IV fluids &amp; blood transfusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>22</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>36</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in children and older adults</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>24</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in neonates and children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Violet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>26</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in neonates</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman has been declared brain dead, and her family has chosen to donate her organs. Who would be the most suitable recipient of her organs?", "options": [{"label": "A", "text": "14-year-old child with multi-organ dysfunction syndrome", "correct": false}, {"label": "B", "text": "50-year alcoholic man with liver cirrhosis with 1 month abstinence", "correct": false}, {"label": "C", "text": "70-year-old woman with end-stage renal disease", "correct": false}, {"label": "D", "text": "32-year-old woman with renal failure", "correct": true}], "correct_answer": "D. 32-year-old woman with renal failure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following 1. Urine Bag 2. Nasogastric Tube 3. Underwater seal bag 4. Suction cannula", "options": [{"label": "A", "text": "1-D, 2-C, 3-A, 4-B", "correct": false}, {"label": "B", "text": "1-C, 2-A, 3-B, 4-D", "correct": true}, {"label": "C", "text": "1-D, 2-A, 3-C, 4-B", "correct": false}, {"label": "D", "text": "1-B, 2-A, 3-C, 4-D", "correct": false}], "correct_answer": "B. 1-C, 2-A, 3-B, 4-D", "question_images": ["https://image.prepladder.com/notes/yrxOzq3ZyEnqql2EK6Wa1746526019.png"], "explanation_images": ["https://image.prepladder.com/notes/Zm4gWyzrAA5UpsUKf1lb1746526083.png", "https://image.prepladder.com/content/aWG5FoeMOBkyPxV6r45A1745480240.png", "https://image.prepladder.com/notes/WhvqIkmuAOijME0hZXut1746526108.png", "https://image.prepladder.com/content/fIB9oRV5fE5tUfJPjNbB1745480229.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:497px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> Bag</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Urine bag\" data-author=\"\" data-hash=\"12223\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"287\" src=\"https://image.prepladder.com/notes/Zm4gWyzrAA5UpsUKf1lb1746526083.png\" width=\"200\"/></p>\n<p>It is a collection bag attached to a <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> inserted into the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to collect and measure urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2. Nasogastric Tube</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/content/aWG5FoeMOBkyPxV6r45A1745480240.png\" width=\"283\"/></p>\n<p>It is flexible tube inserted through the nose and down into the stomach for various <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> or therapeutic</p>\n<p>purposes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3. Underwater seal bag</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Underwater seal bag\" data-author=\"\" data-hash=\"12225\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"258\" src=\"https://image.prepladder.com/notes/WhvqIkmuAOijME0hZXut1746526108.png\" width=\"300\"/></p>\n<p>A device used in chest <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> systems to maintain a seal and prevent air from entering the pleural space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">Suction</span> cannula</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Thomasrive\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Yankauer_Suction_Tip.jpg\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/fIB9oRV5fE5tUfJPjNbB1745480229.png\" width=\"458\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>It is a <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> tube used for the removal of fluid or secretions through suction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The components of qSOFA scoring include: A. Mental status B. Blood pressure C. Respiratory rate D. Heart rate", "options": [{"label": "A", "text": "A &amp;amp; B", "correct": false}, {"label": "B", "text": "C &amp;amp; D", "correct": false}, {"label": "C", "text": "A, B &amp;amp; C", "correct": true}, {"label": "D", "text": "A, B, C &amp;amp; D", "correct": false}], "correct_answer": "C. A, B &amp; C", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the correct answer related to the nerve injuries in various surgeries: A. Breast surgery 1. External Laryngeal nerve B. Thyroid surgery 2. Hypoglossal nerve C. Submandibular excision 3. Phrenic nerve D. Thymectomy 4. Long Thoracic Nerve", "options": [{"label": "A", "text": "A-1, B-2, C-3, D-4", "correct": false}, {"label": "B", "text": "A-2, B-3, C-4, D-1", "correct": false}, {"label": "C", "text": "A-3, B-4, C-1, D-2", "correct": false}, {"label": "D", "text": "A-4, B-1, C-2, D-3", "correct": true}], "correct_answer": "D. A-4, B-1, C-2, D-3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A. Breast surgery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>4. Long <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">Thoracic</span> Nerve</strong></p>\n<ul>\n<li>This nerve is commonly injured during breast surgery, leading to a \"winged scapula”.</li>\n<li>Breast surgery can also lead to Thoracodorsal nerve injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>B. <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> surgery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. External Laryngeal nerve</strong></p>\n<ul>\n<li>It is a branch of the <strong>superior laryngeal nerve</strong> and innervates the <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> muscle; it can be injured during thyroidectomy.</li>\n<li>It leads to <span class=\"customMeta\" data-dictid=\"4da1fe73a71692777189ec55b7ed8c\">hoarseness</span> and difficulty in pitch modulation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C. <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">Submandibular</span> excision</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. <span class=\"customMeta\" data-dictid=\"6983fc06461692777189328d72b4e7\">Hypoglossal</span> nerve</strong></p>\n<ul>\n<li>It supplies motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the muscles of the tongue.</li>\n<li>It runs near the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and can be injured during its excision, leading to <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the tongue towards the affected side.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>D. Thymectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">Phrenic</span> nerve</strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> nerve may be injured during thymectomy, leading to <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> paralysis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is excluded from the primary survey?", "options": [{"label": "A", "text": "Measuring blood pressure", "correct": false}, {"label": "B", "text": "Removing clothes to inspect for wounds", "correct": false}, {"label": "C", "text": "Taking CT scan of the patient", "correct": true}, {"label": "D", "text": "Checking airway patency", "correct": false}], "correct_answer": "C. Taking CT scan of the patient", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Taking &lt;span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\"&gt;CT scan&lt;/span&gt; of th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not taken into consideration in ASEPSIS wound scoring?", "options": [{"label": "A", "text": "Wound swab from the site", "correct": false}, {"label": "B", "text": "Serous discharge", "correct": false}, {"label": "C", "text": "Erythema", "correct": false}, {"label": "D", "text": "Induration", "correct": true}], "correct_answer": "D. Induration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Induration</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A</strong>dditional treatment:</p>\n<ol>\n<li>Antibiotics</li>\n<li>Pus drainage</li>\n<li>Wound debridement</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>10</p>\n<p>5</p>\n<p>10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>erous <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> - For 5 days of the first 7 days of wound infection</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-5 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>E</strong>rythema - For 5 days of first 7 days of wound infection <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-5 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>P</strong>urulent fluid - For 5 days of the first 7 days of wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-10 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>eparation of deep tissues - For 5 days of the first 7 days of wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-10 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I</strong>solation of bacteria <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>tay in the hospital (in-patient) &gt;14 days due to infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the most likely reason for a patient presenting with chronic non-pitting edema in the lower extremities?", "options": [{"label": "A", "text": "Lymphedema", "correct": true}, {"label": "B", "text": "Arterial Disorders", "correct": false}, {"label": "C", "text": "Venous Disorders", "correct": false}, {"label": "D", "text": "Coronary heart disease", "correct": false}], "correct_answer": "A. Lymphedema", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes of Primary Lymphedema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">Lymphedema</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphedema <span class=\"customMeta\" data-dictid=\"96400dd4d61692777196c9a5ea1493\">Praecox</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphedema Tarda </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age: Seen in &lt; 1 year of age</li>\n<li>Present at birth.</li>\n<li>Lower limb, genitalia, and face are involved.</li>\n<li>Usually, B/L and multiple limbs are involved.</li>\n<li>Familial version of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> – known as <strong>Milroy’s disease.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>M/C type of primary <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> (&gt;90% of cases).</li>\n<li>Age: 1 to 35 years.</li>\n<li>M/C seen in females.</li>\n<li>Usually U/L.</li>\n<li>Involves calf and foot</li>\n<li>Familial version of <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> <span class=\"customMeta\" data-dictid=\"96400dd4d61692777196c9a5ea1493\">praecox</span> - known as <strong>Meig's disease.</strong></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age: Usually seen in &gt; 35 years age group</li>\n<li>It is a rare disease.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Lymphedema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Filariasis</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>MC overall cause</strong> of <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> worldwide</li>\n<li><strong>MC secondary cause</strong> of lymphedema</li>\n<li>Lymphoedema due to<strong> <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">Lymphatic</span> obstruction</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Axillary block dissection-</strong>\n<ul>\n<li><strong>MC cause of secondary lymphedema</strong> in the USA</li>\n<li><strong>MC <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> cause</strong> of secondary lymphedema</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Inguinal block dissection</li>\n<li>Lymphedema due to <strong>Lymphatic disruption</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infections</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tuberculosis</li>\n<li>Syphilis</li>\n<li>Fungal and Bacterial infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other causes:</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma</li>\n<li>Malignancy</li>\n<li>Radiotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man was brought to the emergency department after sustaining an RTA and injury to the lower chest. On presentation, the patient is stable, and vitals are normal. Chest radiography showed clear lung fields. What is the next step in management?", "options": [{"label": "A", "text": "eFAST", "correct": true}, {"label": "B", "text": "Tube thoracostomy", "correct": false}, {"label": "C", "text": "CECT chest", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": false}], "correct_answer": "A. eFAST", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Long term diabetic patient with blisters, walked barefoot for a few miles on hot sand. He is presented with this clinical condition. What is the probable diagnosis", "options": [{"label": "A", "text": "Diabetic foot", "correct": false}, {"label": "B", "text": "Burn", "correct": false}, {"label": "C", "text": "Necrotizing fasciitis", "correct": true}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "C. Necrotizing fasciitis", "question_images": ["https://image.prepladder.com/content/tBT8Yec8QsYopec2VOfq1691377538.jpeg"], "explanation_images": ["https://image.prepladder.com/content/Vg1xUc4Lmf4b1bZjGyOw1695541004.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The type of knot seen in the image is?", "options": [{"label": "A", "text": "Half hitch knot", "correct": false}, {"label": "B", "text": "Reef knot", "correct": true}, {"label": "C", "text": "Surgeon’s knot", "correct": false}, {"label": "D", "text": "Crossed half hitch knot", "correct": false}], "correct_answer": "B. Reef knot", "question_images": ["https://image.prepladder.com/content/y0d7aGgVGgaavjsBAbzQ1691504867.png"], "explanation_images": ["https://image.prepladder.com/content/fnMqnTORp29z9QgziRrk1691504890.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following steps was done incorrectly by the intern when placing an intercostal drainage tube in the patient?", "options": [{"label": "A", "text": "Identified 5th intercostal space anterior to mid axillary line to place the tube", "correct": false}, {"label": "B", "text": "Inserted above the upper border of the rib", "correct": false}, {"label": "C", "text": "Insertion of the needle, which will be between your ribs on your back", "correct": true}, {"label": "D", "text": "Incised and digitally explored", "correct": false}], "correct_answer": "C. Insertion of the needle, which will be between your ribs on your back", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the size of the given blade used for incision and drainage of a superficial abscess?", "options": [{"label": "A", "text": "10", "correct": false}, {"label": "B", "text": "11", "correct": true}, {"label": "C", "text": "22", "correct": false}, {"label": "D", "text": "15", "correct": false}], "correct_answer": "B. 11", "question_images": ["https://image.prepladder.com/content/UkOJ85pfejYDv4va0FkO1691504947.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organ is the least susceptible to the blast wave in a blast injury?", "options": [{"label": "A", "text": "Gl tract", "correct": false}, {"label": "B", "text": "Lungs", "correct": false}, {"label": "C", "text": "Liver", "correct": true}, {"label": "D", "text": "Ear drum", "correct": false}], "correct_answer": "C. Liver", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old patient suffering from alcoholic cirrhosis receives a healthy liver from his biological son. What is this type of transplant known as?", "options": [{"label": "A", "text": "Autograft", "correct": false}, {"label": "B", "text": "Allograft", "correct": true}, {"label": "C", "text": "Xenograft", "correct": false}, {"label": "D", "text": "Isograft", "correct": false}], "correct_answer": "B. Allograft", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Glasgow Coma Score of a patient who is making Incomprehensible sounds, opens their eyes in response to painful stimuli and flexes one limb in response to painful stimuli.", "options": [{"label": "A", "text": "9", "correct": false}, {"label": "B", "text": "15", "correct": false}, {"label": "C", "text": "10", "correct": false}, {"label": "D", "text": "8", "correct": true}], "correct_answer": "D. 8", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p><strong>Eye Opening </strong></p>\n</td>\n<td colspan=\"2\">\n<p><strong>Verbal response </strong></p>\n<p><strong>(Mnemonics: “One confused word sounds nowhere\")</strong></p>\n</td>\n<td colspan=\"2\">\n<p><strong>Motor response (best) (Mnemonics: “Obey localities with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and extension\")</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E4</strong></p>\n</td>\n<td>\n<p>Spontaneous</p>\n</td>\n<td>\n<p><strong>V5</strong></p>\n</td>\n<td>\n<p>Oriented</p>\n</td>\n<td>\n<p><strong>M6 </strong></p>\n</td>\n<td>\n<p>Patient obeys command</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E3</strong></p>\n</td>\n<td>\n<p>To loud voice (speech)</p>\n</td>\n<td>\n<p><strong>V4 </strong></p>\n</td>\n<td>\n<p>Disoriented /confused</p>\n</td>\n<td>\n<p><strong>M5</strong></p>\n</td>\n<td>\n<p>Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E2</strong></p>\n</td>\n<td>\n<p>To pain (pressure)</p>\n</td>\n<td>\n<p><strong>V3</strong></p>\n</td>\n<td>\n<p>Inappropriate (words)</p>\n</td>\n<td>\n<p><strong>M4</strong></p>\n</td>\n<td>\n<p>Withdrawal to pain (there is normal flexion)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E1</strong></p>\n</td>\n<td>\n<p>No response</p>\n</td>\n<td>\n<p><strong>V2</strong></p>\n</td>\n<td>\n<p>Incomprehensible (sounds)</p>\n</td>\n<td>\n<p><strong>M3</strong></p>\n</td>\n<td>\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> posturing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>V1</strong></p>\n</td>\n<td>\n<p>No response</p>\n</td>\n<td>\n<p><strong>M2</strong></p>\n</td>\n<td>\n<p>Extension posturing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>M1</strong></p>\n</td>\n<td>\n<p>No response</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient requiring a significant volume of fluids, which colored cannula would be most appropriate to achieve the highest flow rate?", "options": [{"label": "A", "text": "Gray", "correct": true}, {"label": "B", "text": "Green", "correct": false}, {"label": "C", "text": "Blue", "correct": false}, {"label": "D", "text": "Pink", "correct": false}], "correct_answer": "A. Gray", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DCLkEveSqypA89kmgC5A1698228346.png"], "explanation": "<p>Correct Option A.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the hue of the 16F Foley's catheter?", "options": [{"label": "A", "text": "Orange", "correct": true}, {"label": "B", "text": "Blue", "correct": false}, {"label": "C", "text": "Yellow", "correct": false}, {"label": "D", "text": "Black", "correct": false}], "correct_answer": "A. Orange", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man was brought to the emergency department after sustaining an RTA and injury to the lower chest. On presentation, the patient is stable, and vitals are normal . Chest radiography showed clear lung fields. What is the next step in management?", "options": [{"label": "A", "text": "eFAST", "correct": true}, {"label": "B", "text": "Tube thoracostomy", "correct": false}, {"label": "C", "text": "CECT chest", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": false}], "correct_answer": "A. eFAST", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - eFAST\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following CT findings is not an indication to perform angiography in a splenic trauma patient under conservative management?", "options": [{"label": "A", "text": "Subcapsular hematoma covering 40% surface area.", "correct": true}, {"label": "B", "text": "Significant hemoperitoneum", "correct": false}, {"label": "C", "text": "Presence of pseudoaneurysm", "correct": false}, {"label": "D", "text": "Contrast extravasation", "correct": false}], "correct_answer": "A. Subcapsular hematoma covering 40% surface area.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u3CV22G5s3nqBrNDIjvH1712295418.png"], "explanation": "<p>Correct Option A - Subcapsular &lt;span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\"&gt;hematoma&lt;/span&gt; covering 40% su\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Grade</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Hematoma</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Laceration </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>I</p>\n</td>\n<td>\n<p>Subcapsular hematoma</p>\n</td>\n<td>\n<p>Capsular tear &lt;1 cm in depth</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>II</p>\n</td>\n<td>\n<p>S/C <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-50% Surface area</p>\n</td>\n<td>\n<p>1-3cm depth</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>III</p>\n</td>\n<td>\n<p>S/C <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving &gt;50% Surface area</p>\n</td>\n<td>\n<ul>\n<li>\n<p>&gt; 3 cm or involving </p>\n</li>\n<li>\n<p>Trabecular vessels </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>IV</p>\n</td>\n<td>\n<p>&gt;25% devascularization </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Laceration involving</p>\n</li>\n<li>\n<p>Hilar vessels </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>V</p>\n</td>\n<td>\n<p>Completely shattered spleen</p>\n</td>\n<td>\n<p>Complete devascularization </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the subsequent course of action for this injury depicted in the image after a three-day period following a Road Traffic Accident (RTA)?", "options": [{"label": "A", "text": "Debridement of necrotic tissue with primary closure", "correct": false}, {"label": "B", "text": "Debridement of necrotic tissue and hyperbaric oxygen", "correct": true}, {"label": "C", "text": "Amputation", "correct": false}, {"label": "D", "text": "Clean and close with rotation flap", "correct": false}], "correct_answer": "B. Debridement of necrotic tissue and hyperbaric oxygen", "question_images": ["https://image.prepladder.com/content/0yAbaQJFjaH61iOw2Dvt1691237945.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Debridement of necrotic tissue and &lt;span class=\"customMeta\" data-dictid=\"1b1cc7f2861692777189c9bd7d9b81\"&gt;hyperbaric&lt;/span&gt; oxyg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely reason behind the occurrence of surgical emphysema in the patient following an emergency tracheostomy performed outside of the hospital?", "options": [{"label": "A", "text": "Puncture of posterior wall", "correct": false}, {"label": "B", "text": "High tracheostomy", "correct": false}, {"label": "C", "text": "Blockage of the tube", "correct": false}, {"label": "D", "text": "Tight suture", "correct": true}], "correct_answer": "D. Tight suture", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Tight sutu\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:601px\">\n<p><strong>Tracheostomy: Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:236px\">\n<p>Intraoperative complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:365px\">\n<ul>\n<li>Haemorrhage</li>\n<li>Injury to paratracheal structures, particularly the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve and oesophagus</li>\n<li>Damage to the trachea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:236px\">\n<p>Early <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:365px\">\n<ul>\n<li>Apnoea caused by a fall in the PCO<sub>2</sub></li>\n<li>Haemorrhage</li>\n<li>Subcutaneous emphysema, <span class=\"customMeta\" data-dictid=\"989d4f0b441692777196f85841a273\">pneumomediastinum</span> and pneumothorax</li>\n<li>Accidental extubation, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the tube, <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of the tube <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> and lip <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> against the <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> wall</li>\n<li>Infection</li>\n<li>Swallowing dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:236px\">\n<p>Late <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:365px\">\n<ul>\n<li>Difficult decannulation</li>\n<li>Tracheocutaneous fistula</li>\n<li>Tracheo-oesophageal fistula, tracheoinnominate <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> with severe haemorrhage</li>\n<li>Tracheal stenosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the AAST grading system for splenic trauma?", "options": [{"label": "A", "text": "Parenchymal destruction", "correct": false}, {"label": "B", "text": "Vascular involvement", "correct": false}, {"label": "C", "text": "Adjacent organ involvement", "correct": true}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "C. Adjacent organ involvement", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Adjacent organ involv\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:601px\">\n<p><strong>AAST Grading for splenic trauma (American Association for surgery of trauma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:85px\">\n<p><strong>Grade </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:246px\">\n<p><strong>Hematoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:271px\">\n<p><strong>Laceration </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:85px\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:246px\">\n<p>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving &lt; 10% surface area</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:271px\">\n<p>Capsular tear &lt;1 cm in depth</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:85px\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:246px\">\n<p>S/C <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-15% surface area</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:271px\">\n<p>1-3 cm depth</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:85px\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:246px\">\n<p>S/C <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving &gt;50% surface area</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:271px\">\n<p>&gt;3 cm or involving Trabecular vessels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:85px\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:246px\">\n<p>&gt;25% devascularization</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:271px\">\n<p>Laceration involving Hilar vessels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:85px\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:246px\">\n<p>Completely shattered spleen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:271px\">\n<p>Complete devascularization</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What guidance would you provide to the female patient prior to undergoing laparoscopic surgery?", "options": [{"label": "A", "text": "Eat full before surgery.", "correct": false}, {"label": "B", "text": "Drink plenty of water before surgery.", "correct": false}, {"label": "C", "text": "Enema on the night before surgery", "correct": false}, {"label": "D", "text": "NPO for specific hours before surgery", "correct": true}], "correct_answer": "D. NPO for specific hours before surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"cc5c05259716927771933078784603\"&gt;NPO&lt;/span&gt; for specific hours before surg\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Liquid and Food Intake</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Minimum <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">Fasting</span> Period (hours)</strong></p>\n</td>\n</tr>\n<tr>\n<td>Clear liquids (for example, water, clear tea, black coffee, carbonated beverages and fruit juice without pulp)</td>\n<td style=\"text-align:center\">2</td>\n</tr>\n<tr>\n<td>Breast milk</td>\n<td style=\"text-align:center\">4</td>\n</tr>\n<tr>\n<td>Non-human milk, including infant formula </td>\n<td style=\"text-align:center\">6</td>\n</tr>\n<tr>\n<td>Light meal (for example, toast and clear liquids)</td>\n<td style=\"text-align:center\">6</td>\n</tr>\n<tr>\n<td>Regular or heavy meal (may include fried or <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> food, meal)</td>\n<td style=\"text-align:center\">8</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests is not conducted before a blood transfusion for a person with RTA, when a family member is volunteering for blood donation?", "options": [{"label": "A", "text": "Hepatitis A", "correct": true}, {"label": "B", "text": "Hepatitis B", "correct": false}, {"label": "C", "text": "Hepatitis C", "correct": false}, {"label": "D", "text": "HIV 1 &amp;amp; 2", "correct": false}], "correct_answer": "A. Hepatitis A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\"&gt;Hepatitis&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the Glasgow Coma Scale (GCS) of a patient admitted after a road traffic accident who is currently on mechanical ventilation, but is able to open his eyes in response to a verbal command and spontaneously moves all four limbs.", "options": [{"label": "A", "text": "Eyes-2, Verbal-1, Motor-5", "correct": false}, {"label": "B", "text": "Eyes-2, Verbal-NT, Motor-5", "correct": false}, {"label": "C", "text": "Eyes-3, Verbal-1, Motor-6", "correct": false}, {"label": "D", "text": "Eyes-3, Verbal-NT, Motor-6", "correct": true}], "correct_answer": "D. Eyes-3, Verbal-NT, Motor-6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Eyes-3, Verbal-NT, Motor-6\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:575px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p>Eye Opening (E)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p>Verbal Response (V)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p>Motor Response (M)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>E4 Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>V5 Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>M6 Obeys command</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>E3 To loud voice</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>V4 Disoriented</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>M5 Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>E2 To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>V3 Inappropriate</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>M4 Withdrawal to pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>E1 No response</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>V2 Incomprehensible</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>M3 <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">Abnormal</span> flexion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Not testable (VNT)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>M2 Extension posturing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>M1 No response</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the tool utilized for the evaluation of wound infection severity?", "options": [{"label": "A", "text": "ASA classification", "correct": false}, {"label": "B", "text": "SIRS criteria", "correct": false}, {"label": "C", "text": "Southampton grading", "correct": true}, {"label": "D", "text": "APACHE II score", "correct": false}], "correct_answer": "C. Southampton grading", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Southampton grading\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subtypes/Appearance </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> with mild Bruising/Erythema</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IA – Some bruising</p>\n<p>IB – considerable bruising</p>\n<p>IC – Mild erythema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erythema plus other signs of inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IIA – At one point</p>\n<p>IIB – Around the sutures</p>\n<p>IIC – Along the wound</p>\n<p>IID – Around the wound</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clear or haemoserous discharge</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IIIA – At one point only (&lt;2 cm)</p>\n<p>IIB – Along the wound (&gt; 2 cm)</p>\n<p>IIIC – Large volume</p>\n<p>IIID – Prolonged (&gt; 3 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IVA – At one point only (&lt;2 cm)</p>\n<p>IVB – Along the wound (&gt; 2 cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep wound infection with or without tissue breakdown</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective approach for treating the wound depicted in the provided image?", "options": [{"label": "A", "text": "Cleaning and dressing", "correct": true}, {"label": "B", "text": "Debridement and dressing", "correct": false}, {"label": "C", "text": "Cleaning and skin grafting", "correct": false}, {"label": "D", "text": "Cleaning and use of allograft", "correct": false}], "correct_answer": "A. Cleaning and dressing", "question_images": ["https://image.prepladder.com/content/9JpCaj8aNe25KSeqgsdK1695472157.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Cleaning and dressing\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wound Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrasion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial skin injury involving removal of the <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> layer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cleaning with mild <span class=\"customMeta\" data-dictid=\"6678ca4f0916927771817be4d27af2\">antiseptic</span> solution or <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> saline; Dressing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laceration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Torn or jagged wound with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> edges</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cleaning with mild <span class=\"customMeta\" data-dictid=\"6678ca4f0916927771817be4d27af2\">antiseptic</span> solution; Suturing or wound closure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incision</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clean, straight wound created by a sharp instrument or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cleaning with mild <span class=\"customMeta\" data-dictid=\"6678ca4f0916927771817be4d27af2\">antiseptic</span> solution; Suturing or wound closure</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options provided is not considered a part of qSOFA?", "options": [{"label": "A", "text": "Respiratory rate ≥ 22/min", "correct": false}, {"label": "B", "text": "Systolic BP ≤ 100 mm Hg", "correct": false}, {"label": "C", "text": "Altered mental status", "correct": false}, {"label": "D", "text": "Bilateral pupillary reflex", "correct": true}], "correct_answer": "D. Bilateral pupillary reflex", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\"&gt;Bilateral&lt;/span&gt; pu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a feature of SIRS?", "options": [{"label": "A", "text": "Temperature &amp;gt; 38 degrees Celsius", "correct": false}, {"label": "B", "text": "Respiratory Rate &amp;gt; 20/minute and PaCO2 &amp;lt; 35 mmHg", "correct": true}, {"label": "C", "text": "Pulse rate &amp;gt; 90/minute", "correct": false}, {"label": "D", "text": "WBC &amp;gt; 12000/mm3 or &amp;lt; 4000/mm3", "correct": false}], "correct_answer": "B. Respiratory Rate &gt; 20/minute and PaCO2 &lt; 35 mmHg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;Respiratory&lt;/span&gt; Rate &amp;gt; 20/minute and PaCO&lt;sub&gt;2 &lt;/sub&gt;&amp;lt; 35 mmHg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is typically affected when patients experience loss of sensation while shaving after parotidectomy?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": false}, {"label": "B", "text": "Great auricular nerve", "correct": true}, {"label": "C", "text": "Facial nerve", "correct": false}, {"label": "D", "text": "Mandibular nerve", "correct": false}], "correct_answer": "B. Great auricular nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Great &lt;span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\"&gt;auricular&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following instrument?", "options": [{"label": "A", "text": "Unipolar cautery", "correct": true}, {"label": "B", "text": "Bipolar cautery", "correct": false}, {"label": "C", "text": "Harmonic scalpel", "correct": false}, {"label": "D", "text": "Ligasure", "correct": false}], "correct_answer": "A. Unipolar cautery", "question_images": ["https://image.prepladder.com/content/CGP1agiNLX9wfrtUUB6P1695472348.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"ea6fece5431692777201734b84a0f5\"&gt;Unipolar&lt;/span&gt; cau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the instrument depicted below, which is utilized for the creation of a pneumoperitoneum?", "options": [{"label": "A", "text": "Veress needle", "correct": true}, {"label": "B", "text": "Morris' needle", "correct": false}, {"label": "C", "text": "Yankauer suction tip", "correct": false}, {"label": "D", "text": "Von Graefe needle", "correct": false}], "correct_answer": "A. Veress needle", "question_images": ["https://image.prepladder.com/content/cWcPqpEWs0sflLSHCaEg1695472460.png"], "explanation_images": ["https://image.prepladder.com/content/4lSzJintmp2eyImKxVDV1714116187.png", "https://image.prepladder.com/content/nmpLqz5bogzwUA6u3xYi1714116180.png"], "explanation": "<p>Correct Option A - V\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please assess the severity of the bedsore depicted in the provided image.", "options": [{"label": "A", "text": "4", "correct": true}, {"label": "B", "text": "3", "correct": false}, {"label": "C", "text": "2", "correct": false}, {"label": "D", "text": "1", "correct": false}], "correct_answer": "A. 4", "question_images": ["https://image.prepladder.com/content/iB24dR6zbUa7vIUsddFJ1695472521.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Stage 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which intravenous cannula is recommended for a patient who arrived at the emergency room following a road t raffic accident and needs a significant volume of fluids to be administered?", "options": [{"label": "A", "text": "Green", "correct": false}, {"label": "B", "text": "Blue", "correct": false}, {"label": "C", "text": "Pink", "correct": false}, {"label": "D", "text": "Grey", "correct": true}], "correct_answer": "D. Grey", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - G\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Colour code </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Gauge </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Flow rate </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Indications </strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Orange </strong></td>\n<td>14</td>\n<td>240 ml/min </td>\n<td>Trauma and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures </td>\n</tr>\n<tr>\n<td><strong>Grey </strong></td>\n<td>16</td>\n<td>180 ml/min </td>\n<td>Trauma and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures </td>\n</tr>\n<tr>\n<td><strong>Green </strong></td>\n<td>18</td>\n<td>90 ml/min </td>\n<td>Trauma and quick blood transfusion </td>\n</tr>\n<tr>\n<td><strong>Pink </strong></td>\n<td>20</td>\n<td>60 ml/min </td>\n<td>IV fluids/BT</td>\n</tr>\n<tr>\n<td><strong>Blue </strong></td>\n<td>22</td>\n<td>36 ml/min</td>\n<td>Children/older adults </td>\n</tr>\n<tr>\n<td><strong>Yellow </strong></td>\n<td>24</td>\n<td>20 ml/min</td>\n<td>Neonates, children </td>\n</tr>\n<tr>\n<td><strong>Violet </strong></td>\n<td>26</td>\n<td> 13 ml/min </td>\n<td>Neonates </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The instrument given in the image is:", "options": [{"label": "A", "text": "Hemovac", "correct": false}, {"label": "B", "text": "Jackson-Pratt drain", "correct": true}, {"label": "C", "text": "Minivac", "correct": false}, {"label": "D", "text": "Corrugated drain", "correct": false}], "correct_answer": "B. Jackson-Pratt drain", "question_images": ["https://image.prepladder.com/content/e4RRdcCIR9uaLxeZplzA1695473015.png"], "explanation_images": ["https://image.prepladder.com/content/0fXscP7Nvx26M8kPFP9Y1714116667.png", "https://image.prepladder.com/content/GUiEjKzFTvdvdr2QZY491714116654.png", "https://image.prepladder.com/content/HKNpXCHEy5BvQh6ZMQec1714116680.png", "https://image.prepladder.com/content/0gIFEYVOpbTycC9dywsq1714116706.png"], "explanation": "<p>Correct Option B - Jackson-P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a man who arrived at the emergency department with a head injury resulting from a vehicle accident, the preferred diagnostic test is?", "options": [{"label": "A", "text": "CECT (Contrast-enhanced CT)", "correct": false}, {"label": "B", "text": "MRI (Magnetic Resonance Imaging)", "correct": false}, {"label": "C", "text": "NCCT (Non-Contrast CT)", "correct": true}, {"label": "D", "text": "X-ray", "correct": false}], "correct_answer": "C. NCCT (Non-Contrast CT)", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the likely diagnosis for a 40-year-old patient presenting with a femur fracture accompanied by pulmonary infiltration and respiratory distress?", "options": [{"label": "A", "text": "Fat embolism", "correct": true}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Air embolism", "correct": false}, {"label": "D", "text": "Obstruction", "correct": false}], "correct_answer": "A. Fat embolism", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the event of an accident, prompt action should be taken in the initial management following the arrival of the medical team. Excluding", "options": [{"label": "A", "text": "Stabilization of cervical vertebrae", "correct": false}, {"label": "B", "text": "Check BP", "correct": true}, {"label": "C", "text": "Check respiration", "correct": false}, {"label": "D", "text": "GCS score", "correct": false}], "correct_answer": "B. Check BP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Check BP\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown below", "options": [{"label": "A", "text": "Strawberry stain", "correct": false}, {"label": "B", "text": "Erythema multiforme", "correct": false}, {"label": "C", "text": "Erythema subitem", "correct": false}, {"label": "D", "text": "Port wine stain", "correct": true}], "correct_answer": "D. Port wine stain", "question_images": ["https://image.prepladder.com/content/X8eafRstYpcupvhDL7JQ1691374531.jpg"], "explanation_images": ["https://image.prepladder.com/content/7z3qfY0FlCfB75aJgOZS1714038201.png", "https://image.prepladder.com/content/z9Rb0y6AgfSDidkXzp1Z1714038205.png"], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:301px\">\n<p><strong>Port Wine <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">Stain</span> </strong></p>\n<ul>\n<li>Present at birth</li>\n<li>Grows along with child and persists</li>\n<li>Does not regress</li>\n<li>Most commonly present at face in the areas supplied by 5<sup>th</sup> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve (trigeminal nerve)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:301px\"><img src=\"https://image.prepladder.com/content/7z3qfY0FlCfB75aJgOZS1714038201.png\" style=\"height:310px; width:315px\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:301px\">\n<p><strong>Strawberry <span class=\"customMeta\" data-dictid=\"43e163240216927771815a8295437e\">angioma</span> </strong></p>\n<ul>\n<li>Type of <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> hemangioma</li>\n<li>Baby is normal at birth</li>\n<li>Appears at age 1-3 weeks</li>\n<li>Grows along with child by 1 year of age</li>\n<li>Complete involuting in 90% cases by 9 years of age</li>\n<li>Emptying sign is positive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:301px\"><img src=\"https://image.prepladder.com/content/z9Rb0y6AgfSDidkXzp1Z1714038205.png\" style=\"height:297px; width:289px\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Type of necrosis seen in brain is", "options": [{"label": "A", "text": "Coagulative", "correct": false}, {"label": "B", "text": "Liquefactive", "correct": true}, {"label": "C", "text": "Fat", "correct": false}, {"label": "D", "text": "Fibrinoid", "correct": false}], "correct_answer": "B. Liquefactive", "question_images": [], "explanation_images": [], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Type of Necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Causes/Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Coagulative Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Preservation of tissue architecture but loss of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> details</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Ischemia, <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (e.g., myocardial infarction), severe hypoxia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Liquefactive Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces filled with liquid debris</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Brain infarction, <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation, pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Caseous Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Cheese-like appearance, <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Tuberculosis, fungal infections (e.g., histoplasmosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Fat Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue, release of <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Acute pancreatitis, trauma to adipose-rich areas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Fibrinoid Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Deposition of fibrin-like material in vessel walls, associated with immune-mediated reactions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Vasculitis, <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hypertension</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Acute graft rejection occurs within:", "options": [{"label": "A", "text": "Few minutes", "correct": false}, {"label": "B", "text": "Week after the transplant to 3 months afterward", "correct": true}, {"label": "C", "text": "&amp;gt;6 months", "correct": false}, {"label": "D", "text": "&amp;gt;12 months", "correct": false}], "correct_answer": "B. Week after the transplant to 3 months afterward", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Week after the transplant to 3 month\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate immediate response for a conscious patient who presents to the emergency department after a road traffic accident, exhibits single-word speech, and is found to have a respiratory rate of 40 breaths per minute and a blood pressure of 90/40 mm Hg, along with multiple rib fractures?", "options": [{"label": "A", "text": "Urgent IV fluid administration", "correct": false}, {"label": "B", "text": "Intubate the patient", "correct": false}, {"label": "C", "text": "Chest X-ray", "correct": false}, {"label": "D", "text": "Insert needle in 2nd intercostal space", "correct": true}], "correct_answer": "D. Insert needle in 2nd intercostal space", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Insert needle in 2nd &lt;span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\"&gt;intercostal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate technique for the insertion of a Nasogastric tube?", "options": [{"label": "A", "text": "Supine with neck flexed", "correct": false}, {"label": "B", "text": "Supine with neck extended", "correct": false}, {"label": "C", "text": "Sitting with neck flexed", "correct": true}, {"label": "D", "text": "Sitting with neck extended", "correct": false}], "correct_answer": "C. Sitting with neck flexed", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sitting with neck\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 7-day-old infant who has bilious vomiting, significant abdominal distention, absent bowel sounds , and an abdominal X-ray indicating the presence of multiple gas-filled loops?", "options": [{"label": "A", "text": "Hirschsprung disease", "correct": false}, {"label": "B", "text": "Congenital Hypertrophic pyloric stenosis", "correct": false}, {"label": "C", "text": "Duodenal atresia", "correct": false}, {"label": "D", "text": "Malrotation of gut", "correct": true}], "correct_answer": "D. Malrotation of gut", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"142cff3afd1692777191ee3e887515\"&gt;Malrotation&lt;/span&gt; of gu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial treatment for a newborn baby who has abdominal distension, bilious vomiting, failure to pass meconium after 24 hours , and an X-ray showing dilated small bowel loops with no air-fluid levels and a soap bubble appearance in the lower right quadrant?", "options": [{"label": "A", "text": "Paul mikulicz ileostomy", "correct": false}, {"label": "B", "text": "Bishop ileostomy", "correct": false}, {"label": "C", "text": "Contrast enema", "correct": true}, {"label": "D", "text": "Barium enema", "correct": false}], "correct_answer": "C. Contrast enema", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ulZ8DjjSujVFdLj3L4VA1714108330.png"], "explanation": "<p>Correct Option C - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial investigation that should be performed in the case of a 2.0 Kg male baby, born at home as a full-term delivery, who is experiencing excessive frothing shortly after birth and displaying mild respiratory distress, with an unsupervised antenatal period and uncomplicated delivery?", "options": [{"label": "A", "text": "Bronchoscopy with injection of methylene blue", "correct": false}, {"label": "B", "text": "NG Tube insertion and CXR to check position of tube", "correct": true}, {"label": "C", "text": "CT chest", "correct": false}, {"label": "D", "text": "Endoscopy", "correct": false}], "correct_answer": "B. NG Tube insertion and CXR to check position of tube", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - NG Tube &lt;span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\"&gt;insertion&lt;/span&gt; and CXR to check position of tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Determine the Glasgow Coma Scale ( GCS) score for a patient who displays response to pain by opening their eyes, is conscious but confused, unable to perceive time, and demonstrates flexion in response to painful stimuli applied to the arm.", "options": [{"label": "A", "text": "8", "correct": false}, {"label": "B", "text": "9", "correct": false}, {"label": "C", "text": "10", "correct": true}, {"label": "D", "text": "11", "correct": false}], "correct_answer": "C. 10", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Behavior</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Response</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Eye opening</p>\n<p>Response</p>\n</td>\n<td>\n<p>Spontaneously</p>\n<p>To speech</p>\n<p>To pain</p>\n<p>No response</p>\n</td>\n<td>\n<p>4</p>\n<p>3</p>\n<p>2</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Best verbal response</p>\n</td>\n<td>\n<p>Oriented to time, place and person confused</p>\n<p>Inappropriate words</p>\n<p>Incomprehensible sounds</p>\n<p>No response</p>\n</td>\n<td>\n<p>5</p>\n<p>4</p>\n<p>3</p>\n<p>2</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Best motor response</p>\n</td>\n<td>\n<p>Obeys commands</p>\n<p>Moves to <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain</p>\n<p>Flexion withdrawal from pain</p>\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n<p>Abnormal extension (decerebrate)</p>\n<p>No response</p>\n</td>\n<td>\n<p>6</p>\n<p>5</p>\n<p>4</p>\n<p>3</p>\n<p>2</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total score:</p>\n</td>\n<td>\n<p>Best response</p>\n<p>Comatose client</p>\n<p>Totally unresponsive</p>\n</td>\n<td>\n<p>15</p>\n<p>8 or less</p>\n<p>3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Seat Belt injury leads to?", "options": [{"label": "A", "text": "Splenic laceration", "correct": false}, {"label": "B", "text": "Splenic contusion", "correct": false}, {"label": "C", "text": "Mesenteric tear", "correct": true}, {"label": "D", "text": "Mesenteric adenitis", "correct": false}], "correct_answer": "C. Mesenteric tear", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options is not examined by FAST ultrasonography (USG)?", "options": [{"label": "A", "text": "Pericardium", "correct": false}, {"label": "B", "text": "Pleural cavity", "correct": true}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "B. Pleural cavity", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oQlGXELEJLUDJDfFz4qZ1695540486.png"], "explanation": "<p>Correct Option B - Pleural cav\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Could the occurrence of surgical site infection ( SSI ) have been reduced in this patient if prophylactic antibiotics were administered prior to the surgery?", "options": [{"label": "A", "text": "60 minutes before skin incision", "correct": false}, {"label": "B", "text": "1-3 hours before skin incision", "correct": false}, {"label": "C", "text": "At the time of surgical incision:", "correct": true}, {"label": "D", "text": "Night before surgery for peaking of effect", "correct": false}], "correct_answer": "C. At the time of surgical incision:", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - At the time of &lt;span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\"&gt;surgical&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which Instrument is shown below?", "options": [{"label": "A", "text": "Artery forceps", "correct": true}, {"label": "B", "text": "Kocher forceps", "correct": false}, {"label": "C", "text": "Allis forceps", "correct": false}, {"label": "D", "text": "Babcock forceps", "correct": false}], "correct_answer": "A. Artery forceps", "question_images": ["https://image.prepladder.com/content/9sqnoujojKFf45o3mCzD1714554126.png"], "explanation_images": ["https://image.prepladder.com/content/a16lgJjcNjDxonrvqHyf1714110004.png", "https://image.prepladder.com/content/jUPlxG229sV8zn5zmfUl1714109987.png", "https://image.prepladder.com/content/wWC3cEVjlkQpfe4AmK0V1714109972.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\"&gt;Artery&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organ has the highest chances of Graft rejection response?", "options": [{"label": "A", "text": "Cornea", "correct": false}, {"label": "B", "text": "Gut", "correct": true}, {"label": "C", "text": "Liver", "correct": false}, {"label": "D", "text": "Skin", "correct": false}], "correct_answer": "B. Gut", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Gu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the purpose of assessing under-perfusion in hypovolemic shock , which particular organ should be evaluated?", "options": [{"label": "A", "text": "Kidney", "correct": true}, {"label": "B", "text": "Heart", "correct": false}, {"label": "C", "text": "Lung", "correct": false}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "A. Kidney", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - K\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In traumatic cases, shock is most likely due to :", "options": [{"label": "A", "text": "Injury to intra-abdominal solid organ", "correct": true}, {"label": "B", "text": "Head injury", "correct": false}, {"label": "C", "text": "Septicemia", "correct": false}, {"label": "D", "text": "Cardiac failure", "correct": false}], "correct_answer": "A. Injury to intra-abdominal solid organ", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Injury to &lt;span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\"&gt;intra-abdominal&lt;/span&gt; solid organ: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the surgical procedure for an inguinal hernia in a child, the surgeon observes that the bowel is necrotic . Regarding the resection and anastomosis of the bowel, which statement is accurate?", "options": [{"label": "A", "text": "The surgeon must use chromic catgut", "correct": false}, {"label": "B", "text": "The surgeon must not include the submucosa in the sutures", "correct": false}, {"label": "C", "text": "The surgeon must use the single-layer, extramucosal suture technique", "correct": true}, {"label": "D", "text": "The surgeon must use the single-layer seromuscular suture technique", "correct": false}], "correct_answer": "C. The surgeon must use the single-layer, extramucosal suture technique", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - The surgeon must use the single-layer, extramucosal &lt;span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\"&gt;suture&lt;/span&gt; techniqu\n<p><strong>References:</strong></p>\n<ul><li>↳ Technique choice depends on bowel condition, location, surgeon preference, and patient factors.</li><li>↳ Single-Layer, Extramucosal Suture: Outer bowel layers are sutured, excluding the inner mucosal layer. Reduces leakage risk, especially in necrotic bowel cases.</li><li>↳ Double-Layer Technique: Both seromuscular and mucosal layers are sutured separately, offering added reinforcement and widely used in anastomosis.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is a valid statement regarding chromic catgut?", "options": [{"label": "A", "text": "It is made from cat gut", "correct": false}, {"label": "B", "text": "It is made from rabbit gut", "correct": false}, {"label": "C", "text": "It is absorbed by enzymatic degradation and macrophage phagocytosis", "correct": true}, {"label": "D", "text": "It is tanned with nickel salts to improve handling and to resist degradation in tissue", "correct": false}], "correct_answer": "C. It is absorbed by enzymatic degradation and macrophage phagocytosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It is absorbed by &lt;span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\"&gt;enzymatic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\"&gt;degradation&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"2748357f451692777191377abbe2a6\"&gt;macrophage&lt;/span&gt; phag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the instrument shown in the image provided:", "options": [{"label": "A", "text": "Daever’s retractor", "correct": false}, {"label": "B", "text": "Morris retractor", "correct": true}, {"label": "C", "text": "Czerney’s retractor", "correct": false}, {"label": "D", "text": "Double hook retractor", "correct": false}], "correct_answer": "B. Morris retractor", "question_images": ["https://image.prepladder.com/content/3Wef71giku6UyuCV5Mxg1691498388.png"], "explanation_images": ["https://image.prepladder.com/content/fgPX83Oacsa6rdGixukf1687758625.png", "https://image.prepladder.com/content/jkwBO45Nxwg4Rm2wza0R1687758631.png", "https://image.prepladder.com/content/mkGJ7u7l1xYlSuWGy1u51687758636.png", "https://image.prepladder.com/content/mw7iURTQAivUbUOM9TZF1687758641.png"], "explanation": "<p>Correct Option B - M\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>Langenbeck’s </strong></p>\n</td>\n<td>\n<p><strong>Morris </strong></p>\n</td>\n<td>\n<p><strong>Doyen’s </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Handle </strong></p>\n</td>\n<td>\n<p>Fenestrated</p>\n</td>\n<td>\n<p>Fenestrated</p>\n</td>\n<td>\n<p>No fenestration</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Blade </strong></p>\n</td>\n<td>\n<p>Wide</p>\n</td>\n<td>\n<p>Wider &amp; more curved</p>\n</td>\n<td>\n<p>More curved inside</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Tip </strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>More curved</p>\n</td>\n<td>\n<p>More curved</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the procedure of performing a fasciotomy to treat compartment syndrome , the incision is made through the following layers:", "options": [{"label": "A", "text": "Skin and Subcutaneous tissue", "correct": false}, {"label": "B", "text": "Skin, Subcutaneous tissue, Superficial fascia", "correct": false}, {"label": "C", "text": "Skin, Subcutaneous tissue, Superficial fascia and Deep fascia", "correct": true}, {"label": "D", "text": "Skin, Subcutaneous tissue, Superficial fascia, Deep fascia and a few muscular fibres", "correct": false}], "correct_answer": "C. Skin, Subcutaneous tissue, Superficial fascia and Deep fascia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Skin, &lt;span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\"&gt;Subcutaneous&lt;/span&gt; tissue, &lt;span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\"&gt;Superficial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\"&gt;fascia&lt;/span&gt; and D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the calculation method for determining the modified shock index?", "options": [{"label": "A", "text": "HR/SBP", "correct": false}, {"label": "B", "text": "HR/DBP", "correct": false}, {"label": "C", "text": "HR/MAP", "correct": true}, {"label": "D", "text": "PR/SBP", "correct": false}], "correct_answer": "C. HR/MAP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - HR/MAP\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is incorrect regarding the metabolic ebb and flow responses to trauma according to Cuthbertson?", "options": [{"label": "A", "text": "The “ebb” phase is associated with a decline in body temperature and oxygen consumption", "correct": false}, {"label": "B", "text": "The “flow” phase occurs after resuscitation from a state of shock", "correct": false}, {"label": "C", "text": "The “ebb” phase is aimed at reducing posttraumatic energy depletion", "correct": false}, {"label": "D", "text": "The “ebb” phase leads to activation of the innate immune system and induction of the hepatic acute-phase response", "correct": true}], "correct_answer": "D. The “ebb” phase leads to activation of the innate immune system and induction of the hepatic acute-phase response", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - The \"ebb\" phase leads to &lt;span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\"&gt;activation&lt;/span&gt; of the &lt;span class=\"customMeta\" data-dictid=\"cc8345eacd1692777190c2e063a170\"&gt;innate&lt;/span&gt; immune system and &lt;span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\"&gt;induction&lt;/span&gt; of the &lt;span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\"&gt;hepatic&lt;/span&gt; acute-ph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sebaceous cyst is not seen in:", "options": [{"label": "A", "text": "Back", "correct": false}, {"label": "B", "text": "Soles", "correct": true}, {"label": "C", "text": "Scalp", "correct": false}, {"label": "D", "text": "Scrotum", "correct": false}], "correct_answer": "B. Soles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options does not constitute a Hospital-Acquired infection?", "options": [{"label": "A", "text": "Surgical site infection", "correct": false}, {"label": "B", "text": "STD", "correct": true}, {"label": "C", "text": "UTI", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "B. STD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - STD\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Amount of blood loss in class III circulatory failure/Haemorrhagic shock ?", "options": [{"label": "A", "text": "&amp;lt; 15%", "correct": false}, {"label": "B", "text": "15-30%", "correct": false}, {"label": "C", "text": "30-40%", "correct": true}, {"label": "D", "text": "&amp;gt;40%", "correct": false}], "correct_answer": "C. 30-40%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 30-40%: \n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Parameter</strong></td>\n<td style=\"text-align:center\"><strong>Class I</strong></td>\n<td style=\"text-align:center\"><strong>Class II</strong></td>\n<td style=\"text-align:center\"><strong>Class III</strong></td>\n<td style=\"text-align:center\"><strong>Class IV</strong></td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Blood loss (%)</td>\n<td style=\"text-align:center\">0-15%</td>\n<td style=\"text-align:center\">15-30%</td>\n<td style=\"text-align:center\">30-40%</td>\n<td style=\"text-align:center\">&gt; 40%</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">CNS</td>\n<td style=\"text-align:center\">Slightly anxious</td>\n<td style=\"text-align:center\">Mildly anxious</td>\n<td style=\"text-align:center\">Anxious or confused</td>\n<td style=\"text-align:center\">Confused or lethargic</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Pulse (Beats/min)</td>\n<td style=\"text-align:center\">&lt; 100/min</td>\n<td style=\"text-align:center\">&gt; 100/min</td>\n<td style=\"text-align:center\">&gt; 120/min</td>\n<td style=\"text-align:center\">&gt; 140/min</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Blood pressure</td>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">Decreased</td>\n<td style=\"text-align:center\">Decreased</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Pulse pressure</td>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">Decreased</td>\n<td style=\"text-align:center\">Decreased</td>\n<td style=\"text-align:center\">Decreased</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Respiratory Rate</td>\n<td style=\"text-align:center\">14-20/min</td>\n<td style=\"text-align:center\">20-30/min</td>\n<td style=\"text-align:center\">30-40/min</td>\n<td style=\"text-align:center\">&gt; 35/min</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Urine (mL/hr)</td>\n<td style=\"text-align:center\">&gt; 30</td>\n<td style=\"text-align:center\">20-30</td>\n<td style=\"text-align:center\">5-15</td>\n<td style=\"text-align:center\">Negligible/Nil</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Fluid</td>\n<td style=\"text-align:center\">Crystalloid</td>\n<td style=\"text-align:center\">Crystalloid</td>\n<td style=\"text-align:center\">Crystalloid + Blood</td>\n<td style=\"text-align:center\">Crystalloid + Blood</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Base deficit</td>\n<td style=\"text-align:center\">0 to 2 mEq/L</td>\n<td style=\"text-align:center\">2 to 6 mEq/L</td>\n<td style=\"text-align:center\">6 to 10 mEq/L</td>\n<td style=\"text-align:center\">10 mEq/L or less</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the best position for a conscious patient to be in during the insertion of a Ryle's tube?", "options": [{"label": "A", "text": "Supine with neck flexion", "correct": false}, {"label": "B", "text": "Supine with neck extension", "correct": false}, {"label": "C", "text": "Sitting with neck flexion", "correct": true}, {"label": "D", "text": "Sitting with neck extension", "correct": false}], "correct_answer": "C. Sitting with neck flexion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sitting with neck\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following colored cannula will you use to achieve maximum flow rate , in a patient who needs a l arge amount of fluids?", "options": [{"label": "A", "text": "Grey", "correct": true}, {"label": "B", "text": "Green", "correct": false}, {"label": "C", "text": "Blue", "correct": false}, {"label": "D", "text": "Pink", "correct": false}], "correct_answer": "A. Grey", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - G\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p><strong>Colour code </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:132px\">\n<p><strong>Gauge </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p><strong>Flow rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:223px\">\n<p><strong>Indications </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Orange</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>14</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p> 240 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>Trauma and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Grey</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>16</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>180 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>Trauma and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Green</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>18</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>90 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>Trauma and quick blood transfusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Pink</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>60 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>IV fluids/BT</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Blue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>22</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>36 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>Children/older adults</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>24</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>20 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>Neonates, children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Violet</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:132px\">\n<p>26</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>13 ml/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:223px\">\n<p>Neonates</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the casualty after an RTA. He has chest trauma, respiratory rate of 44 and BP is 90/40 mm/Hg . He is conscious and speaks single words. There is a hyper-resonance on the involved side of his chest. What will be your next, immediate step?", "options": [{"label": "A", "text": "Intubate", "correct": false}, {"label": "B", "text": "Insert needle in appropriate intercostal space", "correct": true}, {"label": "C", "text": "Start intravenous fluids urgently", "correct": false}, {"label": "D", "text": "Take a chest X-ray", "correct": false}], "correct_answer": "B. Insert needle in appropriate intercostal space", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Insert needle in appropriate &lt;span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\"&gt;intercostal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Device shown in the image is used for which purpose?", "options": [{"label": "A", "text": "Prevent viral infections", "correct": false}, {"label": "B", "text": "Prevent transfusion related reactions", "correct": true}, {"label": "C", "text": "Prevent infections", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. Prevent transfusion related reactions", "question_images": ["https://image.prepladder.com/content/ZWx7ZTWXNEuM0F8eHLrA1691480286.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Prevent &lt;span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\"&gt;transfusion&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:47px; vertical-align:bottom; width:160px\">\n<p><strong>Device</strong></p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:47px; vertical-align:bottom; width:441px\">\n<p><strong>Leukoreduction Filter</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:46px; width:160px\">\n<p>Purpose</p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:46px; width:441px\">\n<p>To remove white blood cells from donated blood products</p>\n</td>\n</tr>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:46px; width:160px\">\n<p>Function</p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:46px; width:441px\">\n<p>Filters out white blood cells and certain <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> components</p>\n</td>\n</tr>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:46px; width:160px\">\n<p>Main Application</p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:46px; width:441px\">\n<p>Enhancing safety of blood transfusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:107px; width:160px\">\n<p>Benefits</p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:107px; width:441px\">\n<ul>\n<li>Reduces risk of transfusion-related reactions</li>\n<li>Minimizes <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> non-hemolytic reactions, allergic reactions, and some cases of transfusion-related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> lung injury (TRALI)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:127px; width:160px\">\n<p>Additional Benefits</p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:127px; width:441px\">\n<ul>\n<li>May reduce risk of <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections and bacterial/fungal contamination</li>\n</ul>\n<ul>\n<li>Improves <span class=\"customMeta\" data-dictid=\"9f961c54641692777184ddaf41886b\">compatibility</span> and reduces adverse immune responses</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:162px; width:160px\">\n<p>Usage</p>\n</td>\n<td style=\"background-color:white; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:162px; width:441px\">\n<ul>\n<li>Used in blood banks and <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> medicine settings</li>\n<li>Typically employed for <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> of red blood cells and platelets</li>\n<li>May be recommended for specific patient populations at higher risk of complications or <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reactions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The surgical site infection rate expected in a patient with a clean-contaminated wound that is operated upon after antibiotics prophylaxis is:", "options": [{"label": "A", "text": "1-2%", "correct": false}, {"label": "B", "text": "3%", "correct": true}, {"label": "C", "text": "13-20%", "correct": false}, {"label": "D", "text": "20-30%", "correct": false}], "correct_answer": "B. 3%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 3%\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>SSI rates relating to wound <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> with and without using <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of surgery </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infection rate with <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (%) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infection rate without <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (%) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clean (no <span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\">viscus</span> opened)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clean-contaminated (viscus opened, minimal spillage)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-9</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contaminated (open <span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\">viscus</span> with spillage or <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13-20</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dirty (pus or perforation, or <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> through and abscess</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>40</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the principle behind the wound-healing procedure shown in the image below?", "options": [{"label": "A", "text": "Negative pressure wound therapy", "correct": true}, {"label": "B", "text": "Positive pressure wound therapy", "correct": false}, {"label": "C", "text": "Foam therapy", "correct": false}, {"label": "D", "text": "Sponge therapy", "correct": false}], "correct_answer": "A. Negative pressure wound therapy", "question_images": ["https://image.prepladder.com/content/ceRXjZrLZvRz2E1gumc31691488342.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\"&gt;Negative pressure&lt;/span&gt; wound th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the best position for a conscious patient to be in during the insertion of a Ryle's tube ?", "options": [{"label": "A", "text": "Supine with neck flexion", "correct": false}, {"label": "B", "text": "Supine with neck extension", "correct": false}, {"label": "C", "text": "Sitting with neck flexion", "correct": true}, {"label": "D", "text": "Sitting with neck extension", "correct": false}], "correct_answer": "C. Sitting with neck flexion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sitting with neck\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your course of action in the ER when a young man, who has suffered a road traffic accident , arrives with significant blood loss and only one IV line available, necessitating the acquisition of 2 units of packed red blood cells (PRBC) and 4 platelets from the blood bank?", "options": [{"label": "A", "text": "Start PRBC 1 st and store platelet at room temperature", "correct": true}, {"label": "B", "text": "Start platelet and store PRBC at room temperature", "correct": false}, {"label": "C", "text": "Only transfuse PRBC", "correct": false}, {"label": "D", "text": "Transfuse PRBC and store platelet at 2-6 degrees", "correct": false}], "correct_answer": "A. Start PRBC 1 st and store platelet at room temperature", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Start PRBC\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 129 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 35 year old industrial worker presents to the ED with severe pain and burns on his right hand after exposure to hydrofluoric acid. The burns are superficial, with erythema and blistering. What is the most appropriate initial management step?", "options": [{"label": "A", "text": "Immediate surgical debridement", "correct": false}, {"label": "B", "text": "Topical application of calcium gluconate gel", "correct": true}, {"label": "C", "text": "Intravenous calcium gluconate", "correct": false}, {"label": "D", "text": "Bier's block with calcium gluconate 10%", "correct": false}], "correct_answer": "B. Topical application of calcium gluconate gel", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6FK4ljTLe54wttuFhV2W1746792702.mp3", "video": ""}, {"text": "A 40-year-old man suffered burns from a wildfire affecting his entire right upper limb and the front of his torso. What is the total percentage of body surface area that has been burned?", "options": [{"label": "A", "text": "27%", "correct": true}, {"label": "B", "text": "18%", "correct": false}, {"label": "C", "text": "36%", "correct": false}, {"label": "D", "text": "32%", "correct": false}], "correct_answer": "A. 27%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NqZBOw6WWKsBCDSjOjoA1740028475.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/87u3RNOUOStqDmN7zhtV1746792130.mp3", "video": ""}, {"text": "A 29-year-old woman sustained severe burns following a spillage of boiling water in the kitchen by accident. She requires colloid resuscitation after the first 24 hours of crystalloid resuscitation. Which of the following can be used to calculate colloid fluid volume?", "options": [{"label": "A", "text": "Parkland formula", "correct": false}, {"label": "B", "text": "Muir and Barclay regime", "correct": true}, {"label": "C", "text": "Evan’s formula", "correct": false}, {"label": "D", "text": "Galveston regime", "correct": false}], "correct_answer": "B. Muir and Barclay regime", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3H2PLAbhEoARqQQdl1O61746791765.mp3", "video": ""}, {"text": "A 24-year-old boy sustained burns in an accident. He has 20% burns and is of 60 kg. What is the total fluid requirement for a day according to the Parkland regime?", "options": [{"label": "A", "text": "4800 mL", "correct": true}, {"label": "B", "text": "5000 mL", "correct": false}, {"label": "C", "text": "4000 mL", "correct": false}, {"label": "D", "text": "3800 mL", "correct": false}], "correct_answer": "A. 4800 mL", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UoCono4HTrRgUaGAQp4u1746791412.mp3", "video": ""}, {"text": "A 25-year-old male is brought to the emergency department after being found unconscious during a thunderstorm. On examination, he has fern-like marks on his neck (as shown in the image below). After regaining consciousness, he complains of weakness and numbness in his lower limbs. What is the most likely diagnosis of his condition?", "options": [{"label": "A", "text": "Compartment syndrome", "correct": false}, {"label": "B", "text": "Keraunoparalysis", "correct": true}, {"label": "C", "text": "Hypokalemic periodic paralysis", "correct": false}, {"label": "D", "text": "Transient ischemic attack", "correct": false}], "correct_answer": "B. Keraunoparalysis", "question_images": ["https://image.prepladder.com/content/0HTFCZJyvbGpmxZKqPsL1740028631.png"], "explanation_images": ["https://image.prepladder.com/content/ZGTcJI4YrXwKaH2CHVNE1740028708.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nkmA5VadeRIJuMkWOijm1746793158.mp3", "video": ""}, {"text": "A 35-year-old electrician is brought to the emergency department after sustaining an electrical injury while working on a faulty high-voltage switchboard. On examination, he is noted to have an entry wound on his left hand and an exit wound on his right foot and dark urine in the Foley catheter bag. Laboratory tests show the following results: Serum creatinine: 2.5 mg/dL Potassium: 5.8 mEq/L Creatine kinase (CK): 25,000 U/L What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Initiate intravenous fluid resuscitation and monitor urine output", "correct": true}, {"label": "B", "text": "Immediate surgical debridement of the entry and exit wounds", "correct": false}, {"label": "C", "text": "Administer calcium gluconate for hyperkalemia", "correct": false}, {"label": "D", "text": "Start hemodialysis immediately", "correct": false}], "correct_answer": "A. Initiate intravenous fluid resuscitation and monitor urine output", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LtqFuqofQkTklSGBhqq61746792909.mp3", "video": ""}, {"text": "A 32 year old male arrives at the emergency department with severe facial burns after being involved in a car accident. The patient’s facial burns are extensive, covering the entire face and neck region, and have caused significant swelling. He is conscious and in pain, but his airway is patent. Which method of dressing should be chosen for this patient's facial burns, and why?", "options": [{"label": "A", "text": "Exposure Method – To allow continuous monitoring of the facial burns and prevent airway compromise.", "correct": true}, {"label": "B", "text": "Closed Method – To reduce the risk of infection by providing a protective barrier over the burned area.", "correct": false}, {"label": "C", "text": "Exposure Method – To facilitate a moist environment that promotes healing in the facial area.", "correct": false}, {"label": "D", "text": "Closed Method – To minimize fluid loss from the burned area and aid in preventing dehydration.", "correct": false}], "correct_answer": "A. Exposure Method – To allow continuous monitoring of the facial burns and prevent airway compromise.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:641px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exposure method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closed method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> is done.</li>\n<li>Antimicrobials are given 2-3 times/day.</li>\n<li>They are used for burns involving the face &amp; the head.</li>\n<li>Disadvantages:\n\t\t\t\t<ul>\n<li>Increased pain &amp; heat loss.</li>\n<li>Increased risk of cross-contamination.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occlusive <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> is applied over the <span class=\"customMeta\" data-dictid=\"78d28b340916927771810a3fffeb0a\">antimicrobial</span> agent.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> is changed twice daily.</li>\n<li>Advantages:\n\t\t\t\t<ul>\n<li>Decreased pain &amp; heat loss.</li>\n<li>Decreased risk of cross-contamination.</li>\n</ul>\n</li>\n<li>Disadvantages:\n\t\t\t\t<ul>\n<li>Increased risk of bacterial growth if the <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> is not changed twice daily.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RKDoAB4rUi9tdp1pfs031746792509.mp3", "video": ""}, {"text": "A 36 year old male is admitted to the hospital with severe second and third-degree burns. On the fourth day, the patient develops a fever, increased pain in the burned area, and a malodorous discharge from the wound. The burn wound appears to have significant eschar formation. Wound cultures reveal heavy growth of Pseudomonas aeruginosa. Which of the following topical agents would be most appropriate for this patient?", "options": [{"label": "A", "text": "Silver sulfadiazine (1%)", "correct": false}, {"label": "B", "text": "Sulfamylon (Mafenide acetate) (5%/11%)", "correct": true}, {"label": "C", "text": "Silver nitrate (0.5%)", "correct": false}, {"label": "D", "text": "Povidone iodine (5%)", "correct": false}], "correct_answer": "B. Sulfamylon (Mafenide acetate) (5%/11%)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Topical agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages/ Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Silver <span class=\"customMeta\" data-dictid=\"8d61c0e3d516927771995457e14512\">sulfadiazine</span> (1 %)</strong> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Effective against Pseudomonas and <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> negative bacteria</li>\n<li>Does not cause pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neutropenia</li>\n<li>Does not penetrate effectively into eschars</li>\n<li>Should be avoided in pregnancy, <span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\">nursing</span> mothers and infants below 2yrs of age</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sulfamylon (5%/11 % )</strong></p>\n<p><strong>(Mafenide acetate) </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Good antipseudomonal agent</li>\n<li>Good <span class=\"customMeta\" data-dictid=\"6b73f3afaa1692777187f2899b6934\">eschar</span> penetration</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painful</li>\n<li>Can cause acidosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> (0.5%) </strong><strong>(Option C)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also has <span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\">anti</span> Pseudomonal activity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stains burnt area</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Povidone <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> (5%) </strong><strong>(Option D)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used over <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue after <span class=\"customMeta\" data-dictid=\"6b73f3afaa1692777187f2899b6934\">eschar</span> separation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Irritant</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Silver sulphadiazine and</strong></p>\n<p><strong>cerium nitrate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boosts <span class=\"customMeta\" data-dictid=\"5eb50cf561169277718491671207db\">cell-mediated immunity</span> (immunomodulator)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Expensive</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0.025% sodium <span class=\"customMeta\" data-dictid=\"183f5ac20a16927771890da7bafd33\">hypochlorite</span> (Dakin's solution)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Effective against <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> positive organisms</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inhibits epithelialization</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tYfP0DZO3eambg27mfCI1746792323.mp3", "video": ""}, {"text": "A 24-year-old burns patient is receiving fluid resuscitation and is being closely monitored. What should his ideal urine output be?", "options": [{"label": "A", "text": "0.5 mL/kg/hr", "correct": true}, {"label": "B", "text": "3 mL/kg/hr", "correct": false}, {"label": "C", "text": "5 mL/kg/hr", "correct": false}, {"label": "D", "text": "2 mL/kg/hr", "correct": false}], "correct_answer": "A. 0.5 mL/kg/hr", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Patient Group</strong></th>\n<th><strong>Target <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> Output</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Adults</td>\n<td><strong>≥ 0.5 mL/kg/hr</strong></td>\n</tr>\n<tr>\n<td>Children</td>\n<td><strong>1–2 mL/kg/hr</strong></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy contracted burns and is in need of fluid resuscitation. Which of the following formulas can be used to measure the fluid volume?", "options": [{"label": "A", "text": "Parkland formula", "correct": false}, {"label": "B", "text": "Modified Brooke formula", "correct": false}, {"label": "C", "text": "Evan’s formula", "correct": false}, {"label": "D", "text": "Galveston formula", "correct": true}], "correct_answer": "D. Galveston formula", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZIYmEzU5nlO5WwxhxKjp1746791604.mp3", "video": ""}, {"text": "A 70-year-old woman presents to the emergency department after a house fire. She has burns involving parts of her face, neck, and both hands. The total body surface area (TBSA) affected is approximately 12%. After emergency management using ATLS guidelines, What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Discharge with outpatient follow-up for wound care and pain management", "correct": false}, {"label": "B", "text": "Admit to the general medical floor for observation and supportive care", "correct": false}, {"label": "C", "text": "Refer to a burn center for specialized treatment", "correct": true}, {"label": "D", "text": "Manage in the emergency department with fluids and dressings, then discharge", "correct": false}], "correct_answer": "C. Refer to a burn center for specialized treatment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications of referral to burns center</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suspected <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burns on face/neck, hoarseness, stridor, singed facial/nasal hair</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Burns needing fluid resuscitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt;15% TBSA in adults</li>\n<li>&gt;10% in children/elderly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Burns requiring surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deep partial-thickness (deep <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> damage)</li>\n<li>Full-thickness (entire <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> destroyed)</li>\n<li>Circumferential full-thickness (restricted movement)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significant burns</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burns on hands, face, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> and perineum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psychiatric/social concerns</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mental health issues, <span class=\"customMeta\" data-dictid=\"206d300b671692777199a306b7450d\">substance abuse</span> and unstable living conditions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suspected non-accidental injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Delayed presentation, inconsistent history and unexplained injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extremes of age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infants, elderly with thinner skin and higher risk of complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Burns with serious sequelae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-tension electrical burns, <span class=\"customMeta\" data-dictid=\"4cd5db9b1d1692777189291997ae48\">hydrofluoric acid</span> burns, etc.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9R6ywii7MFl3gAnDElPP1746789654.mp3", "video": ""}, {"text": "What is the most commonly used fluid for initial resuscitation in burn patients?", "options": [{"label": "A", "text": "Hypertonic saline", "correct": false}, {"label": "B", "text": "Ringer lactate", "correct": true}, {"label": "C", "text": "5% Dextrose", "correct": false}, {"label": "D", "text": "Albumin", "correct": false}], "correct_answer": "B. Ringer lactate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/X1WhopoII6YGgNF6psx41746791231.mp3", "video": ""}, {"text": "Which of the following complications in a patient with an airway burn most at risk?", "options": [{"label": "A", "text": "Chronic bronchitis", "correct": false}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Acute airway obstruction", "correct": true}, {"label": "D", "text": "Pleural effusion", "correct": false}], "correct_answer": "C. Acute airway obstruction", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zfpoioWnf3aPybjRX82k1746791063.mp3", "video": ""}, {"text": "What is the most common cause of death in the first 24 hours after sustaining severe burns?", "options": [{"label": "A", "text": "Septicemia", "correct": false}, {"label": "B", "text": "Hypovolemic shock", "correct": true}, {"label": "C", "text": "Acute respiratory distress syndrome (ARDS)", "correct": false}, {"label": "D", "text": "Renal failure", "correct": false}], "correct_answer": "B. Hypovolemic shock", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:553px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M/C <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> at the site of accident</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asphyxia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M/C cause of early death in burns</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypovolemic shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M/C cause of late death in burns</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sepsis (M/C organism- Pseudomonas</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XBjJik0GWr1mONGNyPle1746790859.mp3", "video": ""}, {"text": "A 35-year-old male presents to the emergency department with complaints of extensive burns on his back, chest, and legs. On examination, the affected areas are dry, leathery, and charred black with no blister formation.What is the most likely type of burn?", "options": [{"label": "A", "text": "Second-degree burn", "correct": false}, {"label": "B", "text": "First-degree burn", "correct": false}, {"label": "C", "text": "Third-degree burn", "correct": true}, {"label": "D", "text": "Fourth-degree burn", "correct": false}], "correct_answer": "C. Third-degree burn", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bgZQNZOpbkHIXhGASgBd1740028428.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RvFeKBbgPRc5QJI8Ljd51746790670.mp3", "video": ""}, {"text": "Match the type of burn with its corresponding characteristic: Type of Burn Characteristics 1. First-degree burn A. Blistering, partial-thickness damage 2. Second-degree burn B. Charring, full-thickness skin damage 3. Third-degree burn C. Redness, Epidermal burn 4. Fourth-degree burn D. Involvement of muscles and bones", "options": [{"label": "A", "text": "1-C, 2-A, 3-B, 4-D", "correct": true}, {"label": "B", "text": "1-A, 2-B, 3-D, 4-C", "correct": false}, {"label": "C", "text": "1-C, 2-B, 3-A, 4-D", "correct": false}, {"label": "D", "text": "1-D, 2-C, 3-A, 4-B", "correct": false}], "correct_answer": "A. 1-C, 2-A, 3-B, 4-D", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F5SFrVSd7aqEGfOkaToB1740028378.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Burn</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-degree burn </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Redness, <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">Epidermal</span> burn</li>\n<li>Involves only epidermis</li>\n<li>Painful and erythematous with no blisters.</li>\n<li>Healing time:<strong> 5-10 days</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second-degree burn </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blistering, partial-thickness skin damage</li>\n<li>Superficial partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> burn- <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">Epidermis</span> + <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> dermis</li>\n<li>Deep partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> burn- <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">Epidermis</span> + <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> dermis</li>\n<li>Healing time: <strong>2-3 weeks</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Third-degree burn </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Charring, full-thickness skin damage</li>\n<li>Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> + <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fourth-degree burn </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involvement of skin and underlying muscles and bones</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sS43zdgOZvS6aQxoQoKd1746106785.mp3", "video": ""}, {"text": "Which of the following best differentiates deep partial-thickness burns from superficial partial-thickness burns?", "options": [{"label": "A", "text": "Involvement of the epidermis and papillary dermis with visible capillary refill.", "correct": false}, {"label": "B", "text": "Blistering and loss of epidermis with pink and moist dermis.", "correct": false}, {"label": "C", "text": "Healing within 2 weeks without scarring.", "correct": false}, {"label": "D", "text": "Reduced sensation, fixed capillary staining and no blanching with pressure.", "correct": true}], "correct_answer": "D. Reduced sensation, fixed capillary staining and no blanching with pressure.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superficial Partial-Thickness Burns</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deep Partial-Thickness Burns</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidermis and <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> dermis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidermis and <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> dermis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of epidermis</li>\n<li>Blistering</li>\n<li>Pink and moist dermis</li>\n<li>Normal sensation</li>\n<li>Visible <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> refill</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of epidermis</li>\n<li>Less moist dermis</li>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> staining</li>\n<li>Reduced sensation</li>\n<li>No blanching with pressure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heals within 2 weeks without scarring.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Takes 3+ weeks: often leads to scarring.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supportive care, wound protection, and pain management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention (e.g., skin grafting)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RcP2D6eP7J4xqSmvEueE1746790475.mp3", "video": ""}, {"text": "In burn injuries, which zone is characterized by necrotic tissue and irreversible cell damage at the time of injury?", "options": [{"label": "A", "text": "Zone of Hyperemia", "correct": false}, {"label": "B", "text": "Zone of Stasis", "correct": false}, {"label": "C", "text": "Zone of Coagulation", "correct": true}, {"label": "D", "text": "Zone of Inflammation", "correct": false}], "correct_answer": "C. Zone of Coagulation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vHYvPh2B0KmOMiJx2Aat1740028301.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GUiRv6aEjRaNnJRhH2n91746790313.mp3", "video": ""}, {"text": "A 55-year-old male with a history of a recent traumatic brain injury presents with sudden epigastric pain, vomiting of blood, and black stools. He is diagnosed with a Cushing ulcer. Despite initial management with IV fluids and proton pump inhibitors (PPIs), the patient continues to bleed. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Increase the dose of IV PPIs and observe for improvement.", "correct": false}, {"label": "B", "text": "Perform an urgent endoscopy to control the bleeding.", "correct": true}, {"label": "C", "text": "Schedule the patient for a planned surgical vagotomy and pyloroplasty.", "correct": false}, {"label": "D", "text": "Refer the patient for immediate angiography with embolization.", "correct": false}], "correct_answer": "B. Perform an urgent endoscopy to control the bleeding.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cushing Ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cushing's <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> is a gastro-duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> caused by increased<strong> <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (ICP),</strong> commonly due to brain tumors, head injuries or other <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> conditions.</li>\n<li><strong>Vagal Stimulation</strong>: Overstimulation of the <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerve due to elevated <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> leads to increased <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> acid secretion.</li>\n<li><strong>Sympathetic Paralysis</strong>: <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">Disruption</span> in <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> pathways may exacerbate the <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> in <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> secretions, contributing to <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> formation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Epigastric pain</li>\n<li>Nausea and vomiting.</li>\n<li>Gastrointestinal bleeding, presenting as <span class=\"customMeta\" data-dictid=\"a835b61f5216927771880a4c6e0a00\">hematemesis</span> (vomiting blood) or <span class=\"customMeta\" data-dictid=\"cdfd662dbf1692777192da96520d89\">melena</span> (black stools).</li>\n<li>Potential complications include <strong>ulcer perforation</strong> and peritonitis, which are life-threatening if untreated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Prophylaxis may fail</strong> (Option A).</li>\n<li>Resuscitation: Begins with crystalloids and early use of balanced blood products.</li>\n<li>Coagulopathy Correction: FFP or <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> transfusions are needed for <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> or <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> drug use.</li>\n<li>Nasogastric Tube: Key for <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">lavage</span> and <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> in hemorrhagic stress gastritis.</li>\n<li>Antisecretory Agents:<strong> IV PPIs </strong>are preferred over H2 antagonists for <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> control.</li>\n<li>Endoscopy: <strong>First-line </strong>for GI bleeding, effective despite high rebleed risk. (Option B)</li>\n<li>Angiography: For failed endoscopy, involves <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> or <span class=\"customMeta\" data-dictid=\"699f9aa3cf1692777201b501b79deb\">vasopressin</span> infusion. (Option D)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For unresponsive, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or perforations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Approach</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A staged approach starting with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> control is safer.</li>\n<li>Initial Surgery: Long midline <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for exploration; <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"22307f81d716927771886c6c5f6e94\">gastrotomy</span> to oversew <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> sites.</li>\n<li>Stable Patients: <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">Vagotomy</span> and <span class=\"customMeta\" data-dictid=\"9d8d4d8a4316927771968be0696768\">pyloroplasty</span> after <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> control; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> closure.<strong>(Option C)</strong></li>\n<li>Unstable Patients: Leave the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> open for resuscitation; second surgery for <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">vagotomy</span> and <span class=\"customMeta\" data-dictid=\"9d8d4d8a4316927771968be0696768\">pyloroplasty</span> when stable.</li>\n<li>Rare Procedures: Due to the high risks, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> resection, <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">subtotal</span> or total gastrectomy, and <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"ddadff81201692777186bff3a36612\">devascularization</span> are rarely performed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3L9D0GoMZoeEC6dndI711746790091.mp3", "video": ""}, {"text": "Which among the following statements about the body responses to severe burns are true? A) Hypermetabolism after a burn increases oxygen consumption and leads to muscle wasting. B) The zone of coagulation is a reversible area of tissue damage in burns. C) Cardiopulmonary effects in severe burns can result in reduced cardiac output. D) Immune suppression following a burn increases the risk of infection. E) Inflammation and edema in burn injuries cause increased vascular permeability and fluid loss.", "options": [{"label": "A", "text": "All except A and C", "correct": false}, {"label": "B", "text": "All except A and B", "correct": false}, {"label": "C", "text": "All except B", "correct": true}, {"label": "D", "text": "All are correct", "correct": false}], "correct_answer": "C. All except B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PATHOPHYSIOLOGY OF BURNS</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local responses:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burns cause cell <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> and <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> due to rapid temperature changes.</li>\n<li>The depth of injury depends on temperature, exposure duration, and <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> <span class=\"customMeta\" data-dictid=\"91addb33ba1692777184a05ccf8a4a\">conductivity</span> (e.g., oil burns are deeper than water burns).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jackson Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Zone of Coagulation</strong>: <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">Irreversible</span> tissue damage with cell destruction. <strong>(Statement B)</strong></li>\n<li><strong>Zone of Stasis: </strong>Moderate damage with <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> perfusion; survival depends on timely intervention.</li>\n<li><strong>Zone of Hyperemia: </strong>Vasodilation around the wound; generally remains <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> and aids healing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Responses:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammation &amp; Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burns trigger widespread inflammation, increasing <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> permeability, leading to fluid loss, edema, and decreased <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume. <strong>(Statement E)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiopulmonary Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microvascular changes reduce <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output, potentially leading to <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> despite fluid resuscitation. <strong>(Statement C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> affects <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> blood flow, risking <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> if not managed promptly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immune Suppression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burns impair immune function, increasing infection risk due to compromised neutrophils, macrophages, and T lymphocytes. <strong>(Statement D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypermetabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burns induce a <span class=\"customMeta\" data-dictid=\"80b35dd6c116927771894f1a1ef9ea\">hypermetabolic</span> state, leading to increased oxygen consumption, protein/fat breakdown, and muscle wasting.</li>\n<li>The liver plays a key role in <span class=\"customMeta\" data-dictid=\"724a9faafe1692777188ca8840ec5c\">gluconeogenesis</span> and <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid processing. <strong>(Statement A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ebb and Flow Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Post-injury, the body undergoes an <strong>initial low </strong>metabolic rate (ebb phase) followed by a<strong> hypermetabolic</strong> state (flow phase).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Infection</strong>: Early <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> of burns are crucial to prevent infections.</li>\n<li><strong>Organ Failure</strong>: Severe burns can lead to multiple organ failure due to a <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/20IJsSTghPSpj0mrsije1746789905.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "How does the graft get nutrition on day 3?", "options": [{"label": "A", "text": "Imbibition", "correct": false}, {"label": "B", "text": "Inosculation", "correct": true}, {"label": "C", "text": "Neovascularization", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "B. Inosculation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B -Inosculation</p>\n<table>\n<thead>\n<tr>\n<th>Day</th>\n<th>Nutritional Mechanism</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>0–2</td>\n<td>Plasmatic <span class=\"customMeta\" data-dictid=\"dff144d1e51692777189acef767a18\">imbibition</span> (diffusion)</td>\n</tr>\n<tr>\n<td>~3</td>\n<td>Inosculation (capillary connections form)</td>\n</tr>\n<tr>\n<td>4–7</td>\n<td>Neovascularization (new vessels grow in)</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is shown in the given image?", "options": [{"label": "A", "text": "Dermoid cyst", "correct": false}, {"label": "B", "text": "Sebaceous cyst", "correct": true}, {"label": "C", "text": "Meningioma", "correct": false}, {"label": "D", "text": "Post auricular fistula", "correct": false}], "correct_answer": "B. Sebaceous cyst", "question_images": ["https://image.prepladder.com/content/95cXMrkb6wOonaDil8T01691507210.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred management of the condition in the image below?", "options": [{"label": "A", "text": "Surgical excision", "correct": true}, {"label": "B", "text": "Radiotherapy", "correct": false}, {"label": "C", "text": "Antibiotics", "correct": false}, {"label": "D", "text": "Intralesional steroids", "correct": false}], "correct_answer": "A. Surgical excision", "question_images": ["https://image.prepladder.com/content/wVHBRcR4U9F7rUEC00NB1747121564.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Angular Dermoid</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It commonly occurs as<strong> a smooth, non-tender, soft <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the fronto-zygomatic suture.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>They are most often located near the <strong>lateral canthus</strong>, which is the outer corner of the eye where the upper and lower eyelids meet. They may also occur near <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines of the skull.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>They are usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> unless they become large enough to cause pressure effects on adjacent structures or become infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound or CT scans may be used to evaluate the extent of the cyst, especially if deep or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> involvement is suspected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Excision: Complete <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> is the treatment of choice</strong>, especially if the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is causing <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> concerns or other symptoms.</p>\n<ul>\n<li>Careful <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> is required to ensure the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is fully removed and avoid recurrence.</li>\n<li>If left untreated, <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> dermoids sometimes undergo <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> or <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> of the underlying base. CT is done to rule out <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> attachments.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for the lesion developed by a patient after 6 months of undergoing heart surgery, as depicted below?", "options": [{"label": "A", "text": "Hypertrophic scar", "correct": false}, {"label": "B", "text": "Atrophic scar", "correct": false}, {"label": "C", "text": "Keloid scar", "correct": true}, {"label": "D", "text": "Contracture", "correct": false}], "correct_answer": "C. Keloid scar", "question_images": ["https://image.prepladder.com/content/P9GDqB9kPFankwrqORKW1747115286.png"], "explanation_images": ["https://image.prepladder.com/content/Kl3mGfV300eqISVKO8uo1747115314.png", "https://image.prepladder.com/content/lphK4ENmaBkLMsf6EXUe1748162804.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old man presented with a burn injury. He is covered with burns on his head &amp;amp; neck, both upper limbs, front and back of the chest. Calculate the percentage of burns.", "options": [{"label": "A", "text": "27%", "correct": false}, {"label": "B", "text": "36%", "correct": false}, {"label": "C", "text": "45%", "correct": true}, {"label": "D", "text": "18%", "correct": false}], "correct_answer": "C. 45%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AxMoYpMmh3qr1dzC7P5q1745477301.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rule of Nines</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"459\" src=\"https://image.prepladder.com/content/AxMoYpMmh3qr1dzC7P5q1745477301.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding Marjolin’s ulcer is not true?", "options": [{"label": "A", "text": "It is seen in sites of chronic wounds or scars", "correct": false}, {"label": "B", "text": "It rapidly progresses to malignancy", "correct": true}, {"label": "C", "text": "It can progress to squamous cell carcinoma", "correct": false}, {"label": "D", "text": "It is radioresistant due to avascularity", "correct": false}], "correct_answer": "B. It rapidly progresses to malignancy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GokplFaeFxyFlt7NyGBg1746012905.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Marjolin’s Ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low-grade Squamous Cell Carcinoma (SCC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Post-burn scar</li>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> due to trauma</li>\n<li>Chronic discharging <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> sinus</li>\n<li>Post-radiation ulcer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develops in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue due to chronic irritation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless (no nerves in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissues)</li>\n<li>Slow growing</li>\n<li>No regional LN <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (no lymphatics in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation of Choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> followed by a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> cover</li>\n<li>Radiotherapy should be avoided (as it is radio-resistant and also to prevent obliterative end arteritis)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man who has the following lesion over the face. He complains of bleeding while itching. The most likely diagnosis is", "options": [{"label": "A", "text": "Dermatofibrosarcoma", "correct": false}, {"label": "B", "text": "Marjolin’s ulcer", "correct": false}, {"label": "C", "text": "Basal cell carcinoma", "correct": true}, {"label": "D", "text": "Naevus", "correct": false}], "correct_answer": "C. Basal cell carcinoma", "question_images": ["https://image.prepladder.com/content/amPzf14cRNmzGcERZ5bu1746012694.png"], "explanation_images": ["https://image.prepladder.com/content/Hz77GiIUqHnHLpoxEVNN1746012738.png", "https://image.prepladder.com/content/jFaWZzQllclHSF8LxbMe1747911174.png"], "explanation": "<p>Correct answer C) B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pressure greater than __ mm of Hg causes pressure sores.:", "options": [{"label": "A", "text": "33", "correct": true}, {"label": "B", "text": "45", "correct": false}, {"label": "C", "text": "54", "correct": false}, {"label": "D", "text": "67", "correct": false}], "correct_answer": "A. 33", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred management of angular dermoid cyst?", "options": [{"label": "A", "text": "Surgical excision", "correct": true}, {"label": "B", "text": "Wait and watch", "correct": false}, {"label": "C", "text": "Wide local excision with a 2 cm margin", "correct": false}, {"label": "D", "text": "Laser ablation", "correct": false}], "correct_answer": "A. Surgical excision", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who underwent surgery for a lipoma 5 weeks ago now presents with a scar at the incision site that is limited to the original wound boundaries. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Keloid", "correct": false}, {"label": "B", "text": "Exuberant granulation", "correct": false}, {"label": "C", "text": "Hypertrophic scar", "correct": true}, {"label": "D", "text": "Granulation tissue", "correct": false}], "correct_answer": "C. Hypertrophic scar", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Hypertrophic scar</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertrophic Scar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keloid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exuberant <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">Granulation</span> (\"Proud Flesh\")</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulation Tissue</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition leading to a raised <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> within wound boundaries.</p>\n<p><strong>(Option D ruled out )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition extending beyond the wound. <strong>(Option A ruled out )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overgrowth of <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue above skin level. <strong>(Option B ruled out )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early vascularized tissue forming during wound healing. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wound Boundaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to the original wound.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends beyond the wound margins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrudes beyond the skin level.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to wound, but not raised.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weeks after injury.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Months after injury.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early post-injury phase.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forms within days of injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May regress over time.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persists and grows continuously.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires treatment (cauterization or excision).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal component of healing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Areas of high tension (joints, chest, back).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Earlobes, shoulders, chest, upper arms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open wounds, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> sites.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> wound.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collagen organized <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to skin surface.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disorganized, excessive <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, rich in capillaries.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibroblasts, capillaries, and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pressure therapy, steroids, laser therapy (if symptomatic).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intralesional steroids, cryotherapy, <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (high recurrence).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> cautery, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> trimming.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed (normal part of healing).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a woman who has suffered third and fourth degree burns on her back, what would be the appropriate sequence of steps in her treatment?", "options": [{"label": "A", "text": "Resuscitation – reconstruction – debridement", "correct": false}, {"label": "B", "text": "Resuscitation – debridement – allograft or autograft", "correct": true}, {"label": "C", "text": "Debridement – resuscitation – autograft", "correct": false}, {"label": "D", "text": "Debridement – reconstruction – resuscitation", "correct": false}], "correct_answer": "B. Resuscitation – debridement – allograft or autograft", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Burn Degree</strong><br/>\n<br/>\n\t\t\t </p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>First-degree</p>\n</td>\n<td>\n<p>Affect only the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> (outermost layer of skin)<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Redness, pain, and mild swelling<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Cool compresses, pain relief medications, and <span class=\"customMeta\" data-dictid=\"7b57133ce21692777181a83cfe6855\">aloe</span> vera gel</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Second-degree</p>\n</td>\n<td>\n<p>Affect the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> and <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> (second layer of skin)<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Redness, pain, blisters, and swelling<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Cool compresses, pain relief medications, and <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> dressings to prevent infection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Third-degree</p>\n</td>\n<td>\n<p>Affect all layers of the skin, including nerves and blood vessels<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>White or blackened, charred skin, no pain or sensation, and swelling<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Emergency medical treatment, including wound cleaning, antibiotics, and skin grafting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fourth-degree</p>\n</td>\n<td>\n<p>Affect all layers of the skin and underlying tissue, including muscle, tendons, and bones</p>\n</td>\n<td>\n<p>Similar to third-degree burns but with extensive tissue damage and exposed bone</p>\n</td>\n<td>\n<p>Emergency medical treatment, including wound cleaning, antibiotics, and skin grafting</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of graft is used when a patient undergoes skin grafting following a road traffic accident in which the graft is harvested from the patient's own body?", "options": [{"label": "A", "text": "Autograft", "correct": true}, {"label": "B", "text": "Xenograft", "correct": false}, {"label": "C", "text": "Allograft", "correct": false}, {"label": "D", "text": "Isograft", "correct": false}], "correct_answer": "A. Autograft", "question_images": ["https://image.prepladder.com/content/ATIsncjgWlhK08HgQfYd1746171980.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Graft Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Autograft</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue from one site to another on the same individual</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>No risk of immune rejection; high success rate</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Requires a donor site, additional morbidity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Allograft</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue from another individual of the same species</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Availability of larger tissue amounts</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Risk of immune rejection; needs immunosuppression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Xenograft</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue from a different species (e.g., pig to human)</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Readily available; used as temporary grafts</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>High risk of immune rejection; often temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Isograft</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue between genetically identical individuals</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>No risk of immune <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> due to genetic identity</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Limited availability; specific to identical twins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old female was treated for a burn wound in the lower limb 5 years ago. Now she has developed an ulcer in the burn scar as shown in the image below. What is the most probable diagnosis ?", "options": [{"label": "A", "text": "Marjolin’s ulcer", "correct": true}, {"label": "B", "text": "Venous ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "A. Marjolin’s ulcer", "question_images": ["https://image.prepladder.com/content/jCYJ4Oo8qL6EPcTf0oRN1692684444.png"], "explanation_images": [], "explanation": "<p>Correct option A - Marjolin’s u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Estimate the extent of injury for a patient with burns involving the chest, abdomen, right upper limb, and the whole of the right thigh.", "options": [{"label": "A", "text": "45%", "correct": false}, {"label": "B", "text": "27%", "correct": false}, {"label": "C", "text": "36%", "correct": true}, {"label": "D", "text": "31.5%", "correct": false}], "correct_answer": "C. 36%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hqpbr9KN7ci7D0mdI8br1745927812.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of dressing is used to cover this post burn wound?", "options": [{"label": "A", "text": "Split thickness skin graft", "correct": true}, {"label": "B", "text": "Full thickness skin graft", "correct": false}, {"label": "C", "text": "VAC dressing", "correct": false}, {"label": "D", "text": "Normal sumag dressing", "correct": false}], "correct_answer": "A. Split thickness skin graft", "question_images": ["https://image.prepladder.com/content/wWAmE5r18400BY9FsLSi1724851697.png"], "explanation_images": ["https://image.prepladder.com/content/RwI2u0WgTNlBsDaewcNf1724851709.png"], "explanation": "<p>Correct Option A - Split &lt;span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\"&gt;thickness&lt;/span&gt; skin g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the specific instrument utilized for extracting the graft from the healthy region during split thickness skin grafting ?", "options": [{"label": "A", "text": "Dermatome", "correct": false}, {"label": "B", "text": "Silver’s knife", "correct": false}, {"label": "C", "text": "Catlin amputating knife", "correct": false}, {"label": "D", "text": "Humby knife", "correct": true}], "correct_answer": "D. Humby knife", "question_images": ["https://image.prepladder.com/content/EVSnO8PJxMXBlugBurdS1714022784.png"], "explanation_images": ["https://image.prepladder.com/content/iajAjVav7ksnhi1jNl9F1714022801.png", "https://image.prepladder.com/content/dSM7uFM3trLGBsLaensV1714022827.png", "https://image.prepladder.com/content/dfVCaUrhtMAx74MnHRBT1714022858.png"], "explanation": "<p>Correct Option D - Humby k\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "ABCDE rule applies for :", "options": [{"label": "A", "text": "Malignant melanoma", "correct": true}, {"label": "B", "text": "BCC", "correct": false}, {"label": "C", "text": "SCC", "correct": false}, {"label": "D", "text": "Actinic keratosis", "correct": false}], "correct_answer": "A. Malignant melanoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Malig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common subtype of Rodent ulcer is :", "options": [{"label": "A", "text": "Superficial", "correct": false}, {"label": "B", "text": "Cystic", "correct": false}, {"label": "C", "text": "Nodular", "correct": true}, {"label": "D", "text": "Pigmented", "correct": false}], "correct_answer": "C. Nodular", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis of this 60 years of man:", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": false}, {"label": "B", "text": "Plunging Ranula", "correct": false}, {"label": "C", "text": "Epulis", "correct": false}, {"label": "D", "text": "SCC of lip", "correct": true}], "correct_answer": "D. SCC of lip", "question_images": ["https://image.prepladder.com/content/ZIsTuNulygWzH82Bw6ge1714022708.png"], "explanation_images": [], "explanation": "<p>Correct Option D - SCC\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true with regards to a keloid scar ?", "options": [{"label": "A", "text": "The extant does not cross the wound margins", "correct": false}, {"label": "B", "text": "Wide excision of the keloid scar prevents recurrence", "correct": false}, {"label": "C", "text": "Histopathology of a keloid scar shows reduced collagen and increased vascularity", "correct": false}, {"label": "D", "text": "A keloid scar forms due to increase in the level of growth factors", "correct": true}], "correct_answer": "D. A keloid scar forms due to increase in the level of growth factors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A &lt;span class=\"customMeta\" data-dictid=\"76020bd1501692777190627edf191b\"&gt;keloid&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\"&gt;scar&lt;/span&gt; forms due to increase in the level of growth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most suitable graft for performing a femoropopliteal bypass procedure?", "options": [{"label": "A", "text": "Dacron", "correct": false}, {"label": "B", "text": "Great saphenous vein", "correct": true}, {"label": "C", "text": "Polytetrafluoroethylene", "correct": false}, {"label": "D", "text": "Short saphenous vein", "correct": false}], "correct_answer": "B. Great saphenous vein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Great saphenous v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary concern in managing hand injuries ?", "options": [{"label": "A", "text": "Repair to tendons", "correct": true}, {"label": "B", "text": "Repair of skin cover", "correct": false}, {"label": "C", "text": "Repair of nerves", "correct": false}, {"label": "D", "text": "All", "correct": false}], "correct_answer": "A. Repair to tendons", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Repair to tendons: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis?", "options": [{"label": "A", "text": "Sebaceous cyst", "correct": true}, {"label": "B", "text": "Implantation dermoid", "correct": false}, {"label": "C", "text": "Angular dermoid", "correct": false}, {"label": "D", "text": "Lipoma", "correct": false}], "correct_answer": "A. Sebaceous cyst", "question_images": ["https://image.prepladder.com/content/E2muiZDG9hjfQw4nYLrA1714480023.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Sebaceou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A plastic surgeon is visited by a 36-year-old African-American male who has a recurring keloid lesion in his left earlobe due to previous injuries. Despite undergoing surgery to remove the lesion, it consistently returns after the procedure. During the examination, the patient has a painless swelling measuring 2 cm in front of his tragus. What is the most suitable approach to manage this recurrent keloid?", "options": [{"label": "A", "text": "Excisional surgery", "correct": false}, {"label": "B", "text": "Intramarginal excision followed by radiation", "correct": true}, {"label": "C", "text": "Cryosurgery", "correct": false}, {"label": "D", "text": "Silicone gel sheeting", "correct": false}], "correct_answer": "B. Intramarginal excision followed by radiation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Intramarginal &lt;span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\"&gt;excision&lt;/span&gt; followed by radiation: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with a known case of the varicose veins in the lower limbs has developed itching and ulceration around the ankle and calf region for a few days. Venous ulcers of the lower limb usually develop in the area of the calf and ankle. Which ulcer is likely to develop in a long-standing chronic venous ulcer?", "options": [{"label": "A", "text": "Marjolin's ulcer", "correct": true}, {"label": "B", "text": "Aphthous ulcer", "correct": false}, {"label": "C", "text": "Pressure sores", "correct": false}, {"label": "D", "text": "Necrotizing fasciitis", "correct": false}], "correct_answer": "A. Marjolin's ulcer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Marjolin's u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rodent ulcer is:", "options": [{"label": "A", "text": "Squamous cell cancer", "correct": false}, {"label": "B", "text": "Basal cell cancer", "correct": true}, {"label": "C", "text": "Rhinophyma", "correct": false}, {"label": "D", "text": "Adenocarcinoma", "correct": false}], "correct_answer": "B. Basal cell cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady with 50% TBSA burn + involvement of dermis &amp;amp; subcutaneous tissue came to the emergency department. Which degree burn is this:", "options": [{"label": "A", "text": "1 st degree", "correct": false}, {"label": "B", "text": "2 nd degreesuperficial", "correct": false}, {"label": "C", "text": "2 nd degreedeep", "correct": false}, {"label": "D", "text": "3 rd degree", "correct": true}], "correct_answer": "D. 3 rd degree", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DUmZzsRnFKLUVoAdy0yj1687240485.png"], "explanation": "<p>Correct Option D - 3&lt;sup&gt;rd&lt;/sup&gt; deg\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Superficial partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> burn</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Deep partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> burn</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> dermis</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">Reticular</span> dermis</p>\n</li>\n<li>\n<p>Burn surface area in <span class=\"customMeta\" data-dictid=\"66f4e1c35716927771929959483274\">mottled</span> having whitish and pinkish area</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cellulitis is:", "options": [{"label": "A", "text": "Nonsuppurative &amp;amp; Noninvasive", "correct": false}, {"label": "B", "text": "Nonsuppurative &amp;amp; invasive", "correct": false}, {"label": "C", "text": "Suprative &amp;amp; Noninvasive", "correct": false}, {"label": "D", "text": "Suprative &amp;amp; Invasive", "correct": true}], "correct_answer": "D. Suprative &amp; Invasive", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Erysipelas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Cellulitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Well defined margin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Not well defined (Indistinct margins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>MC organism: Strep. pyogenes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>MC organism: Strep. pyogenes (Staph. aureus -rarely)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Associated with bulla/Vesicle formation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Bulla formation in severe cases only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Involvement of upper S/C tissue of lymphatics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Involvement of deeper S/C tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common site</strong>: Face with bridge of nose &amp; cheeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common site</strong>: Legs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the inclusion of a split-thickness skin graft in wound closure on the thigh entail?", "options": [{"label": "A", "text": "Epidermis and full dermis", "correct": false}, {"label": "B", "text": "Epidermis and variable part of the dermis", "correct": true}, {"label": "C", "text": "Epidermis, dermis and fat", "correct": false}, {"label": "D", "text": "Epidermis only", "correct": false}], "correct_answer": "B. Epidermis and variable part of the dermis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Epidermis and variable part of the dermis: \n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>STSG (Thierseh)</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>FTSG (Wolfe's)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Epidermis + part of <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> used.</p>\n</li>\n<li>\n<p>Large <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> can be taken </p>\n</li>\n<li>\n<p>Graft survival: Easy</p>\n</li>\n<li>\n<p>Donor site heals spontaneously. So, reneated grafts can be taken</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Epidermis + full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> used.</p>\n</li>\n<li>\n<p>Only small <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> can be taken</p>\n</li>\n<li>\n<p>Graft survival: Difficult</p>\n</li>\n<li>\n<p>Donor site develops permanent <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> so repeated grafts cannot be taken</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Significant <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> contractions </p>\n</li>\n</ul>\n<p> ↓</p>\n<p> Poor <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n<ul>\n<li>\n<p>Donor sites </p>\n<ul>\n<li>\n<p>Most common: Inner aspect of thigh</p>\n</li>\n<li>\n<p>Upper arm </p>\n</li>\n<li>\n<p>Flexor aspect of forearm </p>\n</li>\n<li>\n<p>Abdominal Wall</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Lesser <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> contractions</p>\n</li>\n</ul>\n<p> ↓</p>\n<p> Better <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance </p>\n<ul>\n<li>\n<p>Donor sites</p>\n<ul>\n<li>\n<p>Upper eye lid </p>\n</li>\n<li>\n<p>Retro <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> skin</p>\n</li>\n<li>\n<p>Supraclavicular skin</p>\n</li>\n<li>\n<p>Antecubital skin</p>\n</li>\n<li>\n<p>Inframammary skin</p>\n</li>\n<li>\n<p>Inguinal skin</p>\n</li>\n<li>\n<p>Genital skin</p>\n</li>\n<li>\n<p>Gluteal skin</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Axilla is not used as donor site for full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> skin grafting </p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 39 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 75-year-old bedridden patient is admitted to the hospital with pneumonia. During routine care, the nurse notices an area of redness and tissue breakdown over the patient's sacrum. The patient has been immobile for several days due to weakness. Which of the following statements is incorrect regarding pressure sores?", "options": [{"label": "A", "text": "Pressure sores occur when external pressure exceeds capillary occlusive pressure of 30 mm Hg", "correct": false}, {"label": "B", "text": "Malnutrition and neurological deficits are contributing factors to pressure sore development", "correct": false}, {"label": "C", "text": "The most common site for pressure sores is the greater trochanter", "correct": true}, {"label": "D", "text": "In case of pressure sores on Malleolus, lateral is more commonly affected than medial", "correct": false}], "correct_answer": "C. The most common site for pressure sores is the greater trochanter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EIdLHSb2KjTuYT1aIQGG1740138534.png", "https://image.prepladder.com/content/SEbGwscpj207ItnWWwX51740138277.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> &amp; <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> due to prolonged pressure</li>\n<li><strong>Other names:</strong>\n<ul>\n<li>Bedsore</li>\n<li>Decubitus ulcer</li>\n<li>Trophic ulcer</li>\n<li>Penetrating ulcer</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>External pressure exceeds <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> pressure <strong>(&gt;30 mm Hg) </strong><strong>(Option A)</strong></li>\n<li>Stoppage of <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leading to ischemia</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and ulceration</li>\n<li>Other contributing mechanisms:\n\t\t\t\t<ul>\n<li>Malnutrition <strong>(Option B)</strong></li>\n<li>Neurological deficit</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mnemonic</strong>: 'Indira Gandhi Stadium Inaugurated By Home Minister Office'</p>\n<ul>\n<li>I - <span class=\"customMeta\" data-dictid=\"626b7893a616927771901552f668af\">Ischium</span> <strong>(Most common site)</strong></li>\n<li>G - Greater trochanter</li>\n<li>S - Sacrum</li>\n<li>H - Heel</li>\n<li>M - <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">Malleolus</span> <strong>(lateral &gt; medial)</strong><strong> (Option D)</strong></li>\n<li>O - Occiput</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location (Common Sites)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally seen in <strong>5 percent</strong> of hospitalized patients</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/357oxnpYEhFobzVxOhcA1748162321.mp3", "video": ""}, {"text": "A 75-year-old bedridden patient in a long-term care facility is found to have a pressure sore on his sacral area during a routine skin assessment. Upon examination, the nurse notices a deep, crater-like wound extending through the dermis into the subcutaneous tissue. The base of the wound appears red, and there is no visible bone, tendon, or muscle. Based on the staging system for pressure sores, how would this be classified?", "options": [{"label": "A", "text": "Stage IV", "correct": false}, {"label": "B", "text": "Stage II", "correct": false}, {"label": "C", "text": "Stage III", "correct": true}, {"label": "D", "text": "Stage I", "correct": false}], "correct_answer": "C. Stage III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PGhx2vEfFa4vxoVK0rx51740138630.png", "https://image.prepladder.com/content/YzrW6y3DSUihRInP3UWm1740138653.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IMJt1XClkWDrVeEK2Fie1748162525.mp3", "video": ""}, {"text": "A 25-year-old woman presents with a raised, firm, reddish-purple lesion extending beyond the margins of a surgical scar on her chest. The scar is from a surgery performed 8 months ago. The lesion is pruritic and occasionally painful. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypertrophic scar", "correct": false}, {"label": "B", "text": "Keloid", "correct": true}, {"label": "C", "text": "Dermatofibroma", "correct": false}, {"label": "D", "text": "Malignant transformation of the scar", "correct": false}], "correct_answer": "B. Keloid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1WXP49dOyeTOM37UgV6o1740139024.png", "https://image.prepladder.com/content/ohNJBlzLs2KMZJNXTjlL1740139058.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keloid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertrophic <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> </strong><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extends beyond the original wound margins</li>\n<li>Continues to grow over time</li>\n<li>More common in darker skin types</li>\n<li>Often appears on chest, shoulders, earlobes</li>\n<li>May be <span class=\"customMeta\" data-dictid=\"69967bcdf91692777196d95fdabe9a\">pruritic</span> or painful</li>\n<li>Does not regress spontaneously</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Htirgan \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Keloid#/media/File:Keloid,_Post_Surgical.JPG\" data-tags=\"\" height=\"204\" src=\"https://image.prepladder.com/content/1WXP49dOyeTOM37UgV6o1740139024.png\" width=\"300\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Remains within the boundaries of the original wound</li>\n<li>Develops within weeks of injury</li>\n<li>May regress over time (usually within a year)</li>\n<li>More common than keloids</li>\n<li>Can occur in any skin type</li>\n<li>May be red, raised, and firm</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Cgomez447\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hypertrophic_scar#/media/File:Hypertrophic_scar_-4_months_after_incident-_2013-04-05_00-46.jpg\" data-tags=\"\" height=\"204\" src=\"https://image.prepladder.com/content/ohNJBlzLs2KMZJNXTjlL1740139058.png\" width=\"240\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aJzAx4a2qLKfCQmHQ4d61748162670.mp3", "video": ""}, {"text": "Which of the following best describes the proliferative phase of wound healing?", "options": [{"label": "A", "text": "Vasoconstriction and thrombus formation", "correct": false}, {"label": "B", "text": "Fibroblast activity and collagen production", "correct": true}, {"label": "C", "text": "Maturation of collagen", "correct": false}, {"label": "D", "text": "Recruitment of neutrophils and macrophages", "correct": false}], "correct_answer": "B. Fibroblast activity and collagen production", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YVCgU6KkSuLdPOz7kxm41740110143.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3rCkk8BIE68bq74x9MiI1748159917.mp3", "video": ""}, {"text": "Which of the following factors is most likely to adversely affect wound healing?", "options": [{"label": "A", "text": "Proper oxygenation", "correct": false}, {"label": "B", "text": "Vitamin A supplementation", "correct": false}, {"label": "C", "text": "Ionizing radiation", "correct": true}, {"label": "D", "text": "Normal body temperature", "correct": false}], "correct_answer": "C. Ionizing radiation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infection</li>\n<li>Ischemia</li>\n<li>Foreign body</li>\n<li>Hematoma</li>\n<li>Movement</li>\n<li>Mechanical stress</li>\n<li>Presence of necrotic tissues</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diabetes mellitus</li>\n<li>Ionizing radiation (impairs wound <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> by causing obliterating <span class=\"customMeta\" data-dictid=\"70ff527a1f1692777187648a182400\">endarteritis</span> and decreasing vascularity)</li>\n<li>Immunocompromised state</li>\n<li>Advancing age</li>\n<li>Malnutrition</li>\n<li>Vitamin A &amp; C deficiency</li>\n<li>Zinc &amp; Iron deficiency</li>\n<li>Drugs (e.g., steroids, doxorubicin)</li>\n<li>Jaundice</li>\n<li>Uremia</li>\n<li>Malignancy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Pju5QT2dFDx8PWWm8cZl1748160171.mp3", "video": ""}, {"text": "A 50-year-old woman undergoes an elective cholecystectomy. How would you classify this surgical wound?", "options": [{"label": "A", "text": "Class I", "correct": false}, {"label": "B", "text": "Class II", "correct": true}, {"label": "C", "text": "Class III", "correct": false}, {"label": "D", "text": "Class IV", "correct": false}], "correct_answer": "B. Class II", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sF5IenoHjp3cCwyJg0HS1749130321.mp3", "video": ""}, {"text": "All of the following measures help prevent surgical site infections except:", "options": [{"label": "A", "text": "Minimizing postoperative hospital stay", "correct": false}, {"label": "B", "text": "Proper hand hygiene and surgical scrubbing", "correct": false}, {"label": "C", "text": "Prolonged use of postoperative drains", "correct": true}, {"label": "D", "text": "Administering preoperative antibiotics at induction", "correct": false}], "correct_answer": "C. Prolonged use of postoperative drains", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zavM0p5YUfOZ8wIQ7Wzy1748160966.mp3", "video": ""}, {"text": "A patient presents with a large, open wound on the lower leg that has been left to heal naturally without surgical closure. This type of healing is best described as:", "options": [{"label": "A", "text": "Healing by primary intention", "correct": false}, {"label": "B", "text": "Healing by secondary intention", "correct": true}, {"label": "C", "text": "Healing by tertiary intention", "correct": false}, {"label": "D", "text": "Delayed primary closure", "correct": false}], "correct_answer": "B. Healing by secondary intention", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JwQEbVrg676Bbo5LgxGw1740137797.png", "https://image.prepladder.com/content/d8FhXHY8Ndzzr8PUJS7H1740137822.png", "https://image.prepladder.com/content/asPc4uZJCkahktEyCJvR1740137850.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jEowIc5PUEV9UE8PNuDo1747153573.mp3", "video": ""}, {"text": "A 68-year-old diabetic patient presents with a non-healing ulcer on their heel that has persisted for 4 months despite regular dressing changes and offloading. The image showing the wound is given below. Based on this clinical scenario, which of the following statements is incorrect?", "options": [{"label": "A", "text": "Chronic wound is a wound that persists beyond 4-12 weeks from its first appearance", "correct": false}, {"label": "B", "text": "Delay in healing most commonly occurs due to prolonged inflammatory phase", "correct": false}, {"label": "C", "text": "Pain is initially severe, but disappears with time due to nociceptor damage", "correct": true}, {"label": "D", "text": "Examples of chronic wounds include vascular ulcers, diabetic ulcers, and pressure sores", "correct": false}], "correct_answer": "C. Pain is initially severe, but disappears with time due to nociceptor damage", "question_images": ["https://image.prepladder.com/content/pJ0UxdHiclnx6gSsLz2U1740137981.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any wound which persists beyond 4-12 weeks despite <span class=\"customMeta\" data-dictid=\"c65831e9cb1692777185d546421397\">conservative treatment</span> (dressing) <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wounds that fail to progress through normal stages of wound healing</li>\n<li>Most commonly prolonged phase is the <strong>Inflammatory phase </strong><strong>(Option B)</strong></li>\n<li>Formation of <strong>microbial biofilms</strong> on wound</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Conservative treatment- </strong> Tried first, though mostly requires aggressive treatment (surgical)</li>\n<li><strong>Surgical treatment-</strong> Debridement, control of infection and inflammation</li>\n<li>Surgical treatment is done when the patient suffers from <span class=\"customMeta\" data-dictid=\"97bb95941c169277719084f48d2547\">intractable</span> pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vascular ulcers <strong>(Option D)</strong></li>\n<li>Diabetic ulcers</li>\n<li>Pressure sores</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DV95Mat8yHl9TxwTAp051748161193.mp3", "video": ""}, {"text": "A 35-year-old factory worker presents to the emergency department with a severe injury to his right forearm after it was caught in a machine, as shown in the picture below. Which of the following statements is incorrect with respect to the injury?", "options": [{"label": "A", "text": "It occurs due to shearing force between tissue planes, usually between subcutaneous tissue and deep fascia or between muscle and bone.", "correct": false}, {"label": "B", "text": "Skin viability is assessed using Fluorescein injection under anesthesia", "correct": false}, {"label": "C", "text": "Characteristic Morel-Lavallée lesion can be seen due to edema of surrounding viable tissue around the wound", "correct": true}, {"label": "D", "text": "Treatment primarily involves a multidisciplinary approach which may require amputation", "correct": false}], "correct_answer": "C. Characteristic Morel-Lavallée lesion can be seen due to edema of surrounding viable tissue around the wound", "question_images": ["https://image.prepladder.com/content/BZGxOuGcJWCyPeuwUeX71740138078.png"], "explanation_images": ["https://image.prepladder.com/content/moe7SOJ9puFN9UPpoZsY1740138118.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Degloving injuries are serious <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> injuries occuring due to shearing force between tissue planes, usually between <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue and deep <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> or between muscle and bone. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avulsion due to shearing force strips off the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> tissues <strong>exposing the <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> bundle, muscles, tendons, and bone</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is mainly based on clinical appearance of the wound</li>\n<li>Tissue <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> is assessed by injecting <span class=\"customMeta\" data-dictid=\"468accc4d3169277720252132f5b85\">Fluorescein</span> intravenously. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wound <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> revision with revascularization</li>\n<li>Flap coverage by skin grafting</li>\n<li>Amputation may be required. <strong>(Option D)</strong></li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> in heavy blood loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DaGWCjgCey5QdmQw3xWX1748161459.mp3", "video": ""}, {"text": "A 25-year-old man is brought to the emergency department following a motorcycle accident. He has a closed fracture of the right tibia and complains of severe pain in his right lower leg. On examination, there is pain on passive stretching of the affected limb and distal sensory disturbances are noted. The emergency physician suspects compartment syndrome. Which of the following is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Immediate fasciotomy without further investigation", "correct": false}, {"label": "B", "text": "Measurement of compartment pressure", "correct": true}, {"label": "C", "text": "Application of a compression bandage to reduce swelling", "correct": false}, {"label": "D", "text": "Administration of intravenous antibiotics", "correct": false}], "correct_answer": "B. Measurement of compartment pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LT28T7DN64SuAh8P20HJ1740138229.png", "https://image.prepladder.com/content/Zv0OUyBPZIGFcz52hZrU1740138174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Common in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> of the leg and in front of the forearm.</p>\n<p>• Because of the closed compartment, pressure increases following fracture, haematoma develops which compresses over the vessel.</p>\n<p>• Leads to <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> of vessels causing <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> ischaemia of the limb presenting with severe pain, pallor, pulselessness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Severe pain</p>\n<p>• Pain on <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> stretching of affected limb</p>\n<p>• <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> disturbances</p>\n<p>• Absence of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses (late sign)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">Compartment</span> pressure is measured</p>\n<p>• Pressure monitor &amp; <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> inserted into muscle compartment</p>\n<p>• Diagnosis confirmed if pressure is greater than 30 mm Hg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fasciotomy:</strong></p>\n<p>• Indication: If <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> pressure is &gt; 30 mmHg</p>\n<p>• Clinical signs and symptoms of <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Two <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> incisions should be given – one on the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and the other on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side</p>\n<p>• <span class=\"customMeta\" data-dictid=\"13e924e3cb169277719021021fc6d2\">Incised</span> layers are:</p>\n<ul>\n<li>Skin</li>\n<li>Subcutaneous fat</li>\n<li>Fascia</li>\n</ul>\n<p>• After incision, the muscle should be bulging through the fascia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UYkND1Vh0s6abgVCuPVF1748161651.mp3", "video": ""}, {"text": "A 65-year-old bedridden patient presents with a stage III pressure sore on the sacrum. Which of the following is the most appropriate initial management approach?", "options": [{"label": "A", "text": "Immediate surgical debridement", "correct": false}, {"label": "B", "text": "Application of hydrocolloid dressing", "correct": true}, {"label": "C", "text": "Negative pressure wound therapy", "correct": false}, {"label": "D", "text": "Flap reconstruction", "correct": false}], "correct_answer": "B. Application of hydrocolloid dressing", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sdJb5ZrFXMhhSvwTKWYk1740138898.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fREAmiEQjsUpkzaGWn8C1748162770.mp3", "video": ""}, {"text": "What is the maximum tensile strength that a mature scar can achieve compared to normal skin?", "options": [{"label": "A", "text": "20-30%", "correct": false}, {"label": "B", "text": "40-50%", "correct": false}, {"label": "C", "text": "70-80%", "correct": true}, {"label": "D", "text": "90-100%", "correct": false}], "correct_answer": "C. 70-80%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4tHyVBznVUGg2l5MD6hM1748162892.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following Clark levels indicates that malignant melanoma has invaded the subcutaneous tissue?", "options": [{"label": "A", "text": "Level II", "correct": false}, {"label": "B", "text": "Level III", "correct": false}, {"label": "C", "text": "Level IV", "correct": false}, {"label": "D", "text": "Level V", "correct": true}], "correct_answer": "D. Level V", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:503px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Clark Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Skin Layer Involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Level I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Epidermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Level II</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Papillary Dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Level III</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Junction of <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> and <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">Reticular</span> Dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Level IV</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Reticular Dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Level V</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Subcutaneous Tissue</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Depth of Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>&lt; 0.75 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Very thin melanoma, confined to the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> layers of the skin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Stage II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>0.75 - 1.5 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Thin to <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> melanoma, with slight invasion into the dermis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Stage III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>1.6 - 4.0 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Intermediate to thick melanoma, with significant invasion into the deeper dermis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Stage IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>&gt; 4.0 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Very thick melanoma, with deep invasion possibly extending into <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S3sqqpLVxEXZoZzdO9SK1748175958.mp3", "video": ""}, {"text": "Which of the following is true regarding basal cell carcinoma?", "options": [{"label": "A", "text": "Superficial BCC typically appears with a thin pearly border", "correct": true}, {"label": "B", "text": "Nodular is the least common type of BCC", "correct": false}, {"label": "C", "text": "Morpheaform variant is the most common type of BCC", "correct": false}, {"label": "D", "text": "The prognosis is very poor for all cases", "correct": false}], "correct_answer": "A. Superficial BCC typically appears with a thin pearly border", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xJU34E3bQJ9qvqhlTjC11748180073.mp3", "video": ""}, {"text": "All of these are used for flap monitoring except:", "options": [{"label": "A", "text": "Clinical assessment", "correct": false}, {"label": "B", "text": "Color Doppler sonography", "correct": false}, {"label": "C", "text": "Microdialysis", "correct": false}, {"label": "D", "text": "None of the above", "correct": true}], "correct_answer": "D. None of the above", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:563px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CLINICAL FEATURE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ARTERIAL INSUFFICIENCY</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VENOUS INSUFFICIENCY</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cold</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Warm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pale/White</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congested, Dusky/blue/purple</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Capillary refill</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quick</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pin-prick</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced blood flow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased blood flow</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xPkrQX9ovU3TmGAE28zF1748179875.mp3", "video": ""}, {"text": "Which of the following types do osteomyocutaneous flaps belong to?", "options": [{"label": "A", "text": "Conjoined flaps", "correct": false}, {"label": "B", "text": "Chimeric flaps", "correct": false}, {"label": "C", "text": "Composite flaps", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Composite flaps", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/o81ZCY5K3Gqucng8HNSJ1740080730.png", "https://image.prepladder.com/content/wM81oVQEFCyjGbXJWjKq1740080756.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1ebIolcPxoMhkOIVv4Ba1748179679.mp3", "video": ""}, {"text": "Which of the following is an example of a free flap?", "options": [{"label": "A", "text": "Z-Plasty", "correct": false}, {"label": "B", "text": "Pectoralis major myocutaneous flap", "correct": false}, {"label": "C", "text": "Radial artery forearm flap", "correct": true}, {"label": "D", "text": "Deltopectoral flap", "correct": false}], "correct_answer": "C. Radial artery forearm flap", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CLAoZnsO0PFtrXbIZdlZ1748179462.mp3", "video": ""}, {"text": "A 45-year-old man presents with a large soft tissue defect on his lower leg following a motorcycle accident. The wound measures 10 cm x 15 cm and involves exposure of the tibia. The plastic surgeon is considering an axial flap for reconstruction. Which of the following statements is incorrect regarding the usage of an axial flap?", "options": [{"label": "A", "text": "Axial pattern flaps derive their blood supply directly from a fasciocutaneous artery that runs beneath the flap's longitudinal axis.", "correct": false}, {"label": "B", "text": "It allows for a larger flap design compared to random pattern flaps and delivers better cosmetic results", "correct": false}, {"label": "C", "text": "Deltopectoral flap is a type of axial flap", "correct": false}, {"label": "D", "text": "Due to larger size, axial flaps require a high complexity, multi-step method for reconstruction of defects", "correct": true}], "correct_answer": "D. Due to larger size, axial flaps require a high complexity, multi-step method for reconstruction of defects", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ucn58TVxWEO7xvtvDKmV1748179285.mp3", "video": ""}, {"text": "Regarding the use of random flaps in grafting, which of the following statements is incorrect?", "options": [{"label": "A", "text": "V-Y Plasty is a random flap used for fingertips and extremities", "correct": false}, {"label": "B", "text": "Random flaps rely on perfusion from the subdermal vascular plexus which is a low-pressure system", "correct": false}, {"label": "C", "text": "Z-Plasty is used for lengthening of tissue and scars.", "correct": false}, {"label": "D", "text": "Due to the tenuous blood supply, a minimum length-width ratio of 3:1 is required", "correct": true}], "correct_answer": "D. Due to the tenuous blood supply, a minimum length-width ratio of 3:1 is required", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/J9OPHdCZXkBBfy7yvxKn1740080079.png", "https://image.prepladder.com/content/LZudmHg6xxNm8GWZ0VCR1740080138.png", "https://image.prepladder.com/content/3EQGQAizCn7VNnQtUMxq1740080178.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>V-Y Plasty</strong></td>\n<td><strong>Z-Plasty</strong></td>\n</tr>\n<tr>\n<td>Used for fingertips and extremities. <strong>(Option A ruled out)</strong></td>\n<td>Used for lengthening of tissue and scars <strong>(Option C ruled out)</strong></td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/LZudmHg6xxNm8GWZ0VCR1740080138.png\" width=\"400\"/></p>\n</td>\n<td>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/3EQGQAizCn7VNnQtUMxq1740080178.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YXWHAfDbytSYqoOgsRf31748179048.mp3", "video": ""}, {"text": "A 48-year-old man presents with a progressively enlarging, painless mass in his groin. A biopsy confirms a diagnosis of soft tissue sarcoma. Which of the following characteristics would most likely increase the probability of lymph node involvement in this patient?", "options": [{"label": "A", "text": "Tumor Size &amp;gt;5 cm", "correct": false}, {"label": "B", "text": "High-grade histology", "correct": false}, {"label": "C", "text": "Rhabdomyosarcoma histotype", "correct": true}, {"label": "D", "text": "Deep location relative to fascia", "correct": false}], "correct_answer": "C. Rhabdomyosarcoma histotype", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/p3nnfzthb5UXGIslPDY81748178891.mp3", "video": ""}, {"text": "A 35-year-old woman with a family history of multiple cancers presents with a soft tissue mass. Genetic testing reveals a TP53 mutation. Which of the following is the most likely clinical course associated with her condition?", "options": [{"label": "A", "text": "Development of multiple benign lipomas", "correct": false}, {"label": "B", "text": "Increased risk of developing gastrointestinal stromal tumors (GIST)", "correct": false}, {"label": "C", "text": "High likelihood of developing soft tissue sarcomas, breast cancer, and brain tumors", "correct": true}, {"label": "D", "text": "Predominantly risk of osteosarcoma and leukemia", "correct": false}], "correct_answer": "C. High likelihood of developing soft tissue sarcomas, breast cancer, and brain tumors", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mutated Gene(s)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Li-Fraumeni Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TP53</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of soft tissue sarcomas, breast cancer, brain tumors, osteosarcoma, <span class=\"customMeta\" data-dictid=\"3f4575b0a516927771805f688177c0\">adrenocortical</span> carcinoma, and other early-onset cancers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurofibromatosis <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> (NF1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NF1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Development of multiple neurofibromas, café-au-lait spots, and <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"782b2a963516927771936bac7aff14\">nerve sheath</span> tumors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gardner's Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>APC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">polyposis</span> (FAP), <span class=\"customMeta\" data-dictid=\"ef7857fffd1692777186e935efc664\">desmoid</span> tumors (a type of aggressive fibromatosis), and <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary Retinoblastoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RB1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk of retinoblastoma, osteosarcoma, and other soft tissue sarcomas; typically present in childhood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Werner Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>WRN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Premature aging, increased risk of various cancers including soft tissue sarcomas, especially in older adults.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gorlin Syndrome (NBCCS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PTCH1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cell carcinomas, jaw cysts, medulloblastomas, and rare occurrences of soft tissue sarcomas like rhabdomyosarcoma.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3LvabIKg6gI3YKIODMDa1748178715.mp3", "video": ""}, {"text": "A 5-year-old boy is brought to the OPD by his mother with complaints of swelling on her nape. On examination, a hard, freely mobile, and slow-growing mass is seen. A photograph of the lesion is shown below. Which of the following is the most appropriate clinical diagnosis for this patient?", "options": [{"label": "A", "text": "Cock’s Peculiar Tumor", "correct": false}, {"label": "B", "text": "Pott’s Puffy Tumor", "correct": false}, {"label": "C", "text": "Pilomatrixoma", "correct": true}, {"label": "D", "text": "Cylindroma", "correct": false}], "correct_answer": "C. Pilomatrixoma", "question_images": ["https://image.prepladder.com/content/5PTR8eM3llH1fTIYB7Lx1740079879.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/p8prNzNYbOQKwdgsEPqM1748177126.mp3", "video": ""}, {"text": "All of the following conditions resolve spontaneously in an infant except", "options": [{"label": "A", "text": "Port wine stain", "correct": true}, {"label": "B", "text": "Strawberry angioma", "correct": false}, {"label": "C", "text": "Salmon patch", "correct": false}, {"label": "D", "text": "Cock’s peculiar tumor", "correct": false}], "correct_answer": "A. Port wine stain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JTE3sPBUnwGCORUkqu511740079646.png", "https://image.prepladder.com/content/ss8CDdJ7TVOJ0nkuczFr1740079683.png", "https://image.prepladder.com/content/wGO6Y7IwwpDIhXKyKum51740079777.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9nLDOip9hF37LpYj7I2Y1748176933.mp3", "video": ""}, {"text": "A 28-year-old female patient came to OPD complaining of swelling on the side of her face. On examination, the swelling was painless, smooth, soft, and non-tender. A CT scan was done to rule out dural attachment and a diagnosis of angular dermoid was made. How will you manage the case?", "options": [{"label": "A", "text": "Surgical excision", "correct": true}, {"label": "B", "text": "Wait and watch", "correct": false}, {"label": "C", "text": "Wide local excision with a 2 cm margin", "correct": false}, {"label": "D", "text": "Laser ablation", "correct": false}], "correct_answer": "A. Surgical excision", "question_images": ["https://image.prepladder.com/content/EJdzO3B591tOjV26Hxam1740079579.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/laOH606XsZ2EAIe8vFF11748176787.mp3", "video": ""}, {"text": "A 64-year-old male patient came to the OPD with complaints of swelling on the back of the neck. O/E the swelling is soft and doughy to the touch and non-tender. A diagnosis of lipoma is made. What is the definitive management of this condition?", "options": [{"label": "A", "text": "Surgical excision", "correct": true}, {"label": "B", "text": "Wide local excision with sentinel node biopsy", "correct": false}, {"label": "C", "text": "Excision of the cyst with the wall", "correct": false}, {"label": "D", "text": "Incision and drainage followed by excision", "correct": false}], "correct_answer": "A. Surgical excision", "question_images": ["https://image.prepladder.com/content/vpZJ0iYWytbEqHDRgrz21740079519.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kAovMgeXR1bUKt5IZIgd1748176675.mp3", "video": ""}, {"text": "A patient came with complaints of a painful swelling present on the trunk. On examination, tenderness and pus discharge present with a black-colored punctum seen. A provisional diagnosis of an infected sebaceous cyst is made. Identify the incorrect statement about this condition.", "options": [{"label": "A", "text": "It contains sebum.", "correct": true}, {"label": "B", "text": "It is a type of retention cyst", "correct": false}, {"label": "C", "text": "Black colored punctum is present on the cyst", "correct": false}, {"label": "D", "text": "There is the proliferation of epidermal cells", "correct": false}], "correct_answer": "A. It contains sebum.", "question_images": ["https://image.prepladder.com/content/tLV3YzFSgFL2fTsEQJYR1740079402.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Tc3HM03BefcoSn0ib6W61748176450.mp3", "video": ""}, {"text": "The following are good prognostic factors for melanoma except", "options": [{"label": "A", "text": "No or very few mitoses (&amp;lt;1 per mm sq)", "correct": false}, {"label": "B", "text": "Lack of ulceration", "correct": false}, {"label": "C", "text": "Absence of Regression", "correct": true}, {"label": "D", "text": "Thinner tumor growth", "correct": false}], "correct_answer": "C. Absence of Regression", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hRbulWBVioWbpsRyq5kr1740078668.png", "https://image.prepladder.com/content/EMR2rw44xH2UVy7O4UaF1740078707.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VjKpGvo6VQ7PnRvFxFtp1748176131.mp3", "video": ""}, {"text": "A patient with a skin graft is experiencing mild swelling and oozing at the graft site 24 hours after surgery. Which phase of graft take is most likely occurring?", "options": [{"label": "A", "text": "Imbibition", "correct": true}, {"label": "B", "text": "Inflammation", "correct": false}, {"label": "C", "text": "Revascularization", "correct": false}, {"label": "D", "text": "Maturation", "correct": false}], "correct_answer": "A. Imbibition", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AxnnKesvFOnVhfF5RFPJ1748173907.mp3", "video": ""}, {"text": "Which of the following statements is true about malignant melanoma?", "options": [{"label": "A", "text": "CK-20 is a positive marker for malignant melanoma", "correct": false}, {"label": "B", "text": "Lentigo Maligna is the most malignant type of malignant melanoma", "correct": false}, {"label": "C", "text": "Lymphatic spread is the common route of metastasis", "correct": true}, {"label": "D", "text": "Most common site of metastasis is the Lymph Node", "correct": false}], "correct_answer": "C. Lymphatic spread is the common route of metastasis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tsabyZHruGjfCxMMCsbZ1740078512.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8CZNCJ8UHjB4Lz5dt3Tu1748175841.mp3", "video": ""}, {"text": "A 70-year-old male presents with a large, aggressive squamous cell carcinoma on his lower lip. After initial treatment attempts, the tumor remains persistent. Which of the following treatment options is most appropriate to ensure complete removal of the tumor while minimizing damage to surrounding healthy tissue?", "options": [{"label": "A", "text": "Cryotherapy", "correct": false}, {"label": "B", "text": "Electrodesiccation and Curettage", "correct": false}, {"label": "C", "text": "Wide Local Excision", "correct": false}, {"label": "D", "text": "Mohs Micrographic Surgery", "correct": true}], "correct_answer": "D. Mohs Micrographic Surgery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RqONrx5WcvTPOwnK5P8N1748175669.mp3", "video": ""}, {"text": "A 65-year-old farmer presents with a persistent, scaly lesion on his ear. The lesion has irregular, everted edges and has been gradually growing as shown below. Which of the following is the most common causative factor for his condition?", "options": [{"label": "A", "text": "Tobacco Use", "correct": false}, {"label": "B", "text": "Arsenic Exposure", "correct": false}, {"label": "C", "text": "Sunlight Exposure", "correct": true}, {"label": "D", "text": "Radiation Exposure", "correct": false}], "correct_answer": "C. Sunlight Exposure", "question_images": ["https://image.prepladder.com/content/uSNfoT65Mn67ymSu2gAy1740078428.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/n33PnXm9g2TJapHIHq3D1745396205.mp3", "video": ""}, {"text": "A 62-year-old male presents with a slow-growing, pearly nodule on his nose. The lesion shows telangiectatic vessels on its surface and has a central depression. Which of the following is the most appropriate diagnostic method to confirm the diagnosis of this skin lesion?", "options": [{"label": "A", "text": "Punch Biopsy", "correct": false}, {"label": "B", "text": "Wedge Biopsy", "correct": true}, {"label": "C", "text": "Excisional Biopsy", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Wedge Biopsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3kwmkd6i2cDCVCgTg6N41740078130.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/e6bBKB6q6Ix7cIWGlSAb1748175188.mp3", "video": ""}, {"text": "A 65-year-old man presents with a non-healing ulcer on the popliteal surface of his leg that has been present for several months. The ulcer developed at the site of a burn scar he sustained 30 years ago. On examination, the ulcer is painless, slow-growing, and has irregular borders as shown in the image? What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Cryotherapy and regular dressing changes", "correct": false}, {"label": "B", "text": "Wide local excision followed by flap cover", "correct": true}, {"label": "C", "text": "Wide local excision followed by flap cover and radiotherapy", "correct": false}, {"label": "D", "text": "Observation and follow-up in 6 months", "correct": false}], "correct_answer": "B. Wide local excision followed by flap cover", "question_images": ["https://image.prepladder.com/content/hutmf4q1rSvLEVsdAx741740077843.png"], "explanation_images": ["https://image.prepladder.com/content/qfHU2GLb5Wj3SUdWX66c1740077919.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Marjolin’s Ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low-grade Squamous Cell Carcinoma (SCC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites of Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Post-burn scar</li>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> due to trauma</li>\n<li>Chronic discharging <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> sinus</li>\n<li>Post-radiation ulcer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Develops in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue due to chronic irritation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless (no nerves in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissues)</li>\n<li>Slow growing</li>\n<li>No regional LN <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (no lymphatics in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of Choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biopsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> followed by <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> cover</li>\n<li>Radiotherapy should be avoided (as it is radio-resistant and also to prevent obliterative end arteritis) <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4Exocs2EcKyASCtny1HA1748175011.mp3", "video": ""}, {"text": "Match the following types of ulcers with their characteristic edge appearance: Conditions Edges 1. Healing Ulcer a. Punched-out edges 2. Ischaemic Ulcer b. Undermined edges 3. Tubercular Ulcer c. Sloping edges 4. Basal Cell Carcinoma d. Everted edges 5. Squamous Cell Carcinoma e. Rolled or Pearly white edges", "options": [{"label": "A", "text": "1-c, 2-a, 3-b, 4-d, 5-e", "correct": false}, {"label": "B", "text": "1-b, 2-c, 3-a, 4-d, 5-e", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-b, 4-e, 5-d", "correct": true}, {"label": "D", "text": "1-b, 2-c, 3-a, 4-e, 5-d", "correct": false}], "correct_answer": "C. 1-c, 2-a, 3-b, 4-e, 5-d", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sCNzH26cdx3qbFLwEDVP1740077713.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of edges</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sloping edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Healing ulcer</strong></li>\n<li><strong>Varicose ulcer</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inner part: </strong>Red (healthy <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue)</li>\n<li><strong>Middle part:</strong> Blue (epithelial proliferation)</li>\n<li><strong>Outer part: </strong>White (scar/fibrous tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Undermined edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tubercular ulcers</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disease process advances in the deeper plane (subcutaneous tissue) whereas (skin) <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> proliferates inwards</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Punched out edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Arterial / Ischemic ulcers</strong></li>\n<li><strong>Gummatous (syphilitic) ulcer</strong></li>\n<li><strong>Trophic ulcer</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to endarteritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Raised and <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">beaded</span> edge</strong></p>\n<p><strong>Rolled out / Pearly white edge</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rodent ulcer- <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">Basal</span> cell carcinoma</strong></li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Beads are due to proliferating active cells</li>\n<li>Pearly white in appearance</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Everted edge / Rolled out edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Squamous cell carcinoma</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to the spill of proliferating <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tissue over the normal skin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zmNLfSIFkiJZ1tVzYNts1748174828.mp3", "video": ""}, {"text": "A 55-year-old man with a history of diabetes presents with a chronic wound on his lower leg. On examination, you observe a well-defined lesion with the following characteristics: The deepest part of the lesion shows exposed muscle tissue. The exposed surface appears red and moist with some granulation tissue. There is a distinct boundary between healthy skin and the wound. A narrow area surrounds the wound where the skin appears different from both the healthy skin and the wound itself. Based on this clinical scenario, which of the following correctly matches the described features with the parts of an ulcer?", "options": [{"label": "A", "text": "Exposed muscle - Floor; Red, moist surface with granulation - Base; Boundary of healthy skin - Edge; Narrow surrounding area - Margin", "correct": false}, {"label": "B", "text": "Exposed muscle - Base; Red, moist surface with granulation - Floor; Boundary of healthy skin - Margin; Narrow surrounding area - Edge", "correct": true}, {"label": "C", "text": "Exposed muscle - Floor; Red, moist surface with granulation - Base; Boundary of healthy skin - Margin; Narrow surrounding area - Edge", "correct": false}, {"label": "D", "text": "Exposed muscle - Base; Red, moist surface with granulation - Edge; Boundary of healthy skin - Floor; Narrow surrounding area - Margin", "correct": false}], "correct_answer": "B. Exposed muscle - Base; Red, moist surface with granulation - Floor; Boundary of healthy skin - Margin; Narrow surrounding area - Edge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pxc9SYCfLyBDd639nvXi1740077643.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CTeiUrRyW2sMwrc87YbD1748174671.mp3", "video": ""}, {"text": "Which of the following is not a type of fasciocutaneous flap?", "options": [{"label": "A", "text": "Radial forearm flap", "correct": false}, {"label": "B", "text": "Groin flap", "correct": false}, {"label": "C", "text": "Tensor fascia lata flap", "correct": true}, {"label": "D", "text": "Scapular flap", "correct": false}], "correct_answer": "C. Tensor fascia lata flap", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ThoaxYIjSq6t9pFslDeC1740077570.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical types based on type of tissue</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cutaneous flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Forehead flap, Deltopectoral flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fasciocutaneous flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radial <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> flap, Scapular flap, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> arm flap, <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">Groin</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> <strong>(Option A, B &amp; D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gluteus maximus muscle flap, Gracilis flap, <strong>Tensor <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> lata muscle flap</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myocutaneous flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pectoralis major <span class=\"customMeta\" data-dictid=\"730fafcc78169277719319b79378c3\">myocutaneous</span> flap, <span class=\"customMeta\" data-dictid=\"12ad4210e4169277719111f356b7ba\">Latissimus</span> <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">dorsi</span> flap—composite flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteomyocutaneous flaps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radius with brachioradialis and skin—composite flap,</li>\n<li>Rib with <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> muscles and skin—composite flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical types based on the source of <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Random Pattern Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rely on low pressure found in subdermal plexus</li>\n<li>Used to reconstruct small but full-thickness defect</li>\n<li>Not amenable to skin grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Axial Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Based on the named vessel</li>\n<li>If the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> remains attached to its <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> blood supply &amp; transferred to a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> known as <span class=\"customMeta\" data-dictid=\"af0f51214e16927771952526edf6bc\">pedicle</span> flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Free Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autogenous transplant of vascularized tissues</li>\n<li>There is <span class=\"customMeta\" data-dictid=\"ddadff81201692777186bff3a36612\">devascularization</span> from donor site &amp; <span class=\"customMeta\" data-dictid=\"854508a102169277719784ea065dd0\">revascularization</span> at recipient bed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aydo3jueB81kRRYHCl3u1748174512.mp3", "video": ""}, {"text": "Which of the following is not an absolute indication for flap surgery?", "options": [{"label": "A", "text": "Post-burn contractures", "correct": false}, {"label": "B", "text": "Exposed bony prominences in the joint area", "correct": false}, {"label": "C", "text": "Radiated vessel", "correct": false}, {"label": "D", "text": "Stage III bedsores", "correct": true}], "correct_answer": "D. Stage III bedsores", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8gtcNgB2vjaN3eHVJXbT1747153370.mp3", "video": ""}, {"text": "A 30-year-old patient with extensive third-degree burns requires skin grafting. The surgical team opts for a meshed split-thickness skin graft (STSG). Which of the following is a key benefit of using a meshed skin graft in this scenario?", "options": [{"label": "A", "text": "Enhanced cosmetic appearance", "correct": false}, {"label": "B", "text": "Coverage of a large area with minimal donor skin", "correct": true}, {"label": "C", "text": "Reduced risk of secondary contraction", "correct": false}, {"label": "D", "text": "Decreased need for vascularization", "correct": false}], "correct_answer": "B. Coverage of a large area with minimal donor skin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/023xjuDbG55ycTWqE4An1740077362.png", "https://image.prepladder.com/content/SZzAOZmFaVPKosJo0qaY1740077400.png", "https://image.prepladder.com/content/dkXhZofGsD8fqGm6s0uV1740077485.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gPFUMiWBfSjIPArMjN8w1748174373.mp3", "video": ""}, {"text": "A 45-year-old male undergoes a split-thickness skin graft for a large wound on his leg. Three days postoperatively, the graft appears swollen with fluid accumulating underneath it. Which of the following complications is most likely?", "options": [{"label": "A", "text": "Graft failure", "correct": false}, {"label": "B", "text": "Hematoma or seroma formation", "correct": true}, {"label": "C", "text": "Infection", "correct": false}, {"label": "D", "text": "Poor cosmetic outcome", "correct": false}], "correct_answer": "B. Hematoma or seroma formation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ykSZzgpY1XwLxQtqtM9E1748174242.mp3", "video": ""}, {"text": "A patient needs a graft to cover a small, non-weight-bearing area that is prone to contraction. Which type of graft would be most appropriate to minimize the risk of contraction?", "options": [{"label": "A", "text": "Thiersch graft, due to its minimal contraction", "correct": false}, {"label": "B", "text": "Wolfe graft, due to its full-thickness nature", "correct": true}, {"label": "C", "text": "Split-thickness graft, because it can cover larger areas", "correct": false}, {"label": "D", "text": "Composite graft, because it includes skin and underlying tissue", "correct": false}], "correct_answer": "B. Wolfe graft, due to its full-thickness nature", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thiersch <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">Graft</span> </strong></p>\n<p><strong>(Split-Thickness Skin Graft)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wolfe <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">Graft</span> </strong></p>\n<p><strong>(Full-Thickness Skin Graft)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Skin Grafting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Split-thickness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Full-thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidermis + part of dermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidermis + full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large grafts can be taken</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only small grafts can be taken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft Survival</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Easier</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More difficult</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Donor Site Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heals spontaneously, allowing repeated grafts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> develops, preventing repeated grafts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft Contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant contraction, leading to poor <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesser contraction, better <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Donor Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inner thigh, upper arm, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> aspect of forearm, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper eyelid, retro <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> skin, <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> skin, <span class=\"customMeta\" data-dictid=\"116f4dd59e169277718172685cecb2\">antecubital</span> skin, <span class=\"customMeta\" data-dictid=\"5f4a18606116927771909db4d0fe2f\">inframammary</span> skin, inguinal skin, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> skin, <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Donor Site Exclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axilla is not used as a donor site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages of Harvesting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"b24aa5ceb516927771836a4cb7dd29\">calibration</span> of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> and large area coverage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calibration of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> for small but thick grafts</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KO2Ojt0ol2sUH5joojMI1748174131.mp3", "video": ""}, {"text": "During a skin grafting procedure, the surgeon opts for a tool that can precisely control the thickness of the graft to ensure uniformity. Which of the following instruments is most appropriate for this task?", "options": [{"label": "A", "text": "Surgical scissors", "correct": false}, {"label": "B", "text": "Dermabrader", "correct": false}, {"label": "C", "text": "Ferris-Smith forceps", "correct": false}, {"label": "D", "text": "Electric dermatome", "correct": true}], "correct_answer": "D. Electric dermatome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nSw6fiLy4dffZEaRy6Se1740076924.png", "https://image.prepladder.com/content/AwmneTMa1pdUzpiauaAf1740076944.png", "https://image.prepladder.com/content/ANChpigYdpNJJHEyt2MY1740076970.png", "https://image.prepladder.com/content/YUbX5os2KBkx90vSrVMj1740077005.png", "https://image.prepladder.com/content/qlvwMIGbkDE4CLwXS9vF1740077043.png", "https://image.prepladder.com/content/CN2BBsYcN4tajZVQgoyS1740077078.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VrZG526osn59UkPra7qN1748174020.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 39 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A middle-aged woman presents with flank pain and dysuria. The pain was temporarily relieved by intravenous analgesics administered at a nearby primary healthcare center. She is diagnosed with ureteric colic secondary to ureteric calculi. What is the most appropriate diagnostic modality in this case?", "options": [{"label": "A", "text": "NCCT KUB", "correct": true}, {"label": "B", "text": "СЕСТ", "correct": false}, {"label": "C", "text": "USG KUB", "correct": false}, {"label": "D", "text": "Ureteroscopy", "correct": false}], "correct_answer": "A. NCCT KUB", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations for <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urinalysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This is often the <strong>initial investigation</strong> performed. It can reveal the presence of blood (hematuria), white blood cells (pyuria), and crystals in the urine, all suggestive of a possible stone.</li>\n<li>The pH of the <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> can also give clues about the type of stone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kidney, Ureter, and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> (KUB) X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can detect some types of stones, particularly calcium-containing stones, which appear <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> on X-rays.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasound</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It's particularly useful for detecting <span class=\"customMeta\" data-dictid=\"441df40d111692777189b0e31acb06\">hydronephrosis</span> (swelling of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> due to <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> blockage) caused by stones and can be <strong>helpful during pregnancy </strong>when minimising radiation exposure is important.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"0b9f3942041692777201e61954e325\">urogram</span> (IVU)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It involves injecting a contrast <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> into a vein.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> travels through the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> to the kidneys, where it is filtered and excreted in the urine.</li>\n<li>X-rays are taken as the <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> passes through the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract, outlining the kidneys, ureters, and bladder.</li>\n<li>This test can reveal blockages in the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> caused by stones.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure on prostate biopsy:", "options": [{"label": "A", "text": "Psammoma bodies", "correct": false}, {"label": "B", "text": "Corpora arenacea", "correct": false}, {"label": "C", "text": "Amyloid", "correct": false}, {"label": "D", "text": "Corpora amylacea", "correct": true}], "correct_answer": "D. Corpora amylacea", "question_images": ["https://image.prepladder.com/content/ZMtW7r8rdJ5hgmLXF0lB1741856049.png"], "explanation_images": ["https://image.prepladder.com/content/6Elk1iX5qNkOsc5iVtJ51741228665.png", "https://image.prepladder.com/content/uxBFhCTmJtWHfQ47pkE81741228707.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn male presents with urinary retention, lethargy and a distended bladder. Antenatal ultrasound showed a \"keyhole sign\" with a thickened bladder wall. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypospadias", "correct": false}, {"label": "B", "text": "Vesicoureteral reflux", "correct": false}, {"label": "C", "text": "Posterior urethral valves", "correct": true}, {"label": "D", "text": "Neurogenic bladder", "correct": false}], "correct_answer": "C. Posterior urethral valves", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior urethral valves </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants from membranous folds in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> urethra.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> from oligohydramnios.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> urethral folds</p>\n<p>Type II: Membranes at <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck</p>\n<p>Type III: Round <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> at verumontanum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital, unclear embryological origin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> pressure → hypertrophy, <span class=\"customMeta\" data-dictid=\"639b2545551692777201eeadb06d68\">vesicoureteric</span> reflux, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tools</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound, <span class=\"customMeta\" data-dictid=\"1fbf40a1d316927772018a8e73e615\">VCUG</span> (voiding cystourethrogram) and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> scintigraphy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antenatal Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Dilated <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (\"keyhole sign\"), thickened walls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postnatal Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary retention, infections, lethargy, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antenatal: Vesicostomy, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> ablation</li>\n<li>Postnatal: Stabilization, <span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\">cystoscopic</span> ablation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on severity; long-term care needed for CKD, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> dysfunction, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTIs.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents to the emergency department with a strong urge to urinate but is unable to do so. He has a history of perineal trauma. On examination, blood is noted at the external urethral meatus. Which structure is most likely injured?", "options": [{"label": "A", "text": "Bulbar urethra", "correct": true}, {"label": "B", "text": "Posterior urethral valve", "correct": false}, {"label": "C", "text": "Intraperitoneal Bladder rupture", "correct": false}, {"label": "D", "text": "Membranous urethra", "correct": false}], "correct_answer": "A. Bulbar urethra", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urethral Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Anterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straddle injuries, <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood at meatus, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention, <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> hematoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Posterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-riding prostate, inability to pass urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraperitoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Rupture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peritonitis, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> ascites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Urethral Valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital anomaly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent UTIs, voiding difficulty</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the outpatient department (OPD) with a radiological image as given. What is the most appropriate management for this condition?", "options": [{"label": "A", "text": "Endoscopic ablation", "correct": true}, {"label": "B", "text": "Dilation of urethra", "correct": false}, {"label": "C", "text": "Dilation of urethra and bladder", "correct": false}, {"label": "D", "text": "Conservative", "correct": false}], "correct_answer": "A. Endoscopic ablation", "question_images": ["https://image.prepladder.com/content/U9he1HdNok4QPF2T9MVy1724937059.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\"&gt;Endoscopic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents to the outpatient department (OPD) with recurrent colicky abdominal pain. Urine examination reveals the presence of red blood cells (RBCs). What is the most likely diagnosis?", "options": [{"label": "A", "text": "Glomerulonephritis", "correct": false}, {"label": "B", "text": "Oxalate stone", "correct": false}, {"label": "C", "text": "Polycystic kidney disease", "correct": false}, {"label": "D", "text": "Cystine stone", "correct": true}], "correct_answer": "D. Cystine stone", "question_images": ["https://image.prepladder.com/content/TrGRGyzxXdiLXWYoxTKa1724851089.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"c65131cb591692777185e8b4d0055f\"&gt;Cystine&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old child presents to the outpatient department (OPD) with a complaint of scrotal pain, with a history of trauma 6 hours prior. Upon surgical exploration, the findings suggest significant damage. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Testicular torsion with gangrene", "correct": true}, {"label": "B", "text": "Torsion of testicular appendages with gangrene", "correct": false}, {"label": "C", "text": "Gangrene", "correct": false}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "A. Testicular torsion with gangrene", "question_images": ["https://image.prepladder.com/content/LH2OUQ2ZmjQB38aBPJm01724838936.png"], "explanation_images": ["https://image.prepladder.com/content/iGmoopopIJya7XTG1MSH1724908799.png", "https://image.prepladder.com/content/sD2cywLy0oTV1FGuxc491724908808.png", "https://image.prepladder.com/content/phm5UetPk04eC7LppV371724908822.png"], "explanation": "<p>Correct Option A - Testicular &lt;span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\"&gt;torsion&lt;/span&gt; with gang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What instrument is used to insert this tube?", "options": [{"label": "A", "text": "Nephroscope", "correct": false}, {"label": "B", "text": "Cysto urethroscope", "correct": true}, {"label": "C", "text": "Ureteroscope", "correct": false}, {"label": "D", "text": "Endoscope", "correct": false}], "correct_answer": "B. Cysto urethroscope", "question_images": ["https://image.prepladder.com/content/STTQzU5WKvGpVBgvSIcZ1724928610.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Cysto-ureth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the emergency department with a history of fall and head injury. What is the diagnosis?", "options": [{"label": "A", "text": "EDH", "correct": false}, {"label": "B", "text": "SDH", "correct": true}, {"label": "C", "text": "SAH", "correct": false}, {"label": "D", "text": "Contusion", "correct": false}], "correct_answer": "B. SDH", "question_images": ["https://image.prepladder.com/content/k28Xszr6ZTtMbZnIzJQg1724838186.png"], "explanation_images": ["https://image.prepladder.com/content/BLof4iiVir5MjD6Weyf61724913688.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\"&gt;Subdural&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\"&gt;Hematoma&lt;/span&gt; (SDH)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure done.", "options": [{"label": "A", "text": "Orchidectomy", "correct": false}, {"label": "B", "text": "Total penectomy", "correct": true}, {"label": "C", "text": "Partial penectomy", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Total penectomy", "question_images": ["https://image.prepladder.com/content/iZyXccPirbw2aPmVl7Wo1724839486.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Total P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a growth over the penis that is classified as a T3 lesion, with no enlarged inguinal lymph nodes detected. What is the best method of management?", "options": [{"label": "A", "text": "Penectomy", "correct": false}, {"label": "B", "text": "Penectomy with orchidectomy", "correct": false}, {"label": "C", "text": "Penectomy with superficial/inguinal lymph node dissection(MODIFIED)", "correct": true}, {"label": "D", "text": "Penectomy with deep inguinal lymph node dissection", "correct": false}], "correct_answer": "C. Penectomy with superficial/inguinal lymph node dissection(MODIFIED)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Penectomy with Superficial/Inguinal &lt;span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\"&gt;Lymph&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\"&gt;Node&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\"&gt;Dissection&lt;/span&gt; (MODIFIED)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with a bulky scrotal swelling. On evaluation, malignancy is suspected, and an orchidectomy is performed. The gross section of the testicular mass is shown in the image. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Seminoma", "correct": true}, {"label": "B", "text": "Teratoma", "correct": false}, {"label": "C", "text": "Yolk sac tumour", "correct": false}, {"label": "D", "text": "Endodermal sinus tumor", "correct": false}], "correct_answer": "A. Seminoma", "question_images": ["https://image.prepladder.com/notes/MNMZZlW7sZT2JM3bgzHt1747643957.png"], "explanation_images": ["https://image.prepladder.com/content/OpZHQV4Cy0CyIqqh1eq01747293245.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seminoma, the most common pure testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> aged 25-45</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Germinal <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, firm <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or mass in the testicle, typically unilateral. Accounts for 50% of all testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors. 10% have secondary hydrocele, 5% have gynecomastia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFP: Normal</p>\n<p>hCG: Normal or mildly elevated</p>\n<p>LDH: Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound: Homogeneous, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> mass</p>\n<p>Histology: Sheets of <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> cells with clear cytoplasm, large <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> with prominent <span class=\"customMeta\" data-dictid=\"829d67cd9816927771800b7303f9cc\">acidophilic</span> nucleoli</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg#mw-jump-to-license\" data-tags=\"\" height=\"675\" src=\"https://image.prepladder.com/content/OpZHQV4Cy0CyIqqh1eq01747293245.png\" width=\"675\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>FNAC: Contraindicated due to risk of tumor cell seeding and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary: High Inguinal Radical Orchidectomy</p>\n<p>Adjuvant: Radiation therapy or <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> for positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumor marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFP (Alpha-fetoprotein)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumor</li>\n<li>Embryonal carcinoma</li>\n<li>Teratoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HCG (Human Chorionic Gonadotropin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Choriocarcinoma</li>\n<li>Embryonal carcinoma</li>\n<li>Mixed Germ Cell Tumor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH (Lactate Dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PLAP (Placenta Like Alkaline Phosphatase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GGT (Gamma Glutamyl Transpeptidase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An adult male presents to the outpatient department with a painful scrotal swelling accompanied by fever. The swelling is associated with the tunica vaginalis and is characterized by fluid accumulation. What is the likely diagnosis?", "options": [{"label": "A", "text": "Varicocele", "correct": false}, {"label": "B", "text": "Hydrocele", "correct": true}, {"label": "C", "text": "Cystocele", "correct": false}, {"label": "D", "text": "Torsion testis", "correct": false}], "correct_answer": "B. Hydrocele", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Aetiology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Defective <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of fluid by <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis due to endothelial wall damage by <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> infection</li>\n<li>Excessive production of fluid (secondary hydrocele)</li>\n<li>Interference with <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of fluid by <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels of the cord</li>\n<li>Communication with the peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in middle-aged men, prevalent in tropical countries</li>\n<li>Testis is usually large and non-palpable</li>\n<li>Fluctuant</li>\n<li>Can get above the swelling</li>\n<li>Initially transilluminant, but becomes non-transilluminant if long-standing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infantile Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tunica and <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis distended up to the internal ring</li>\n<li>No connection with the peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Processus vaginalis communicates with the peritoneal cavity</li>\n<li>Fluid disappears when lying down and recollects when standing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Encysted <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">Hydrocele</span> of the Cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fluid collection in a portion of the patent <span class=\"customMeta\" data-dictid=\"5f2b559f9d1692777203a2e3ac1ba6\">funicular process</span> of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</li>\n<li>Fluctuant and transilluminant</li>\n<li>Located in the inguinal/inguinoscrotal/scrotal part</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secondary <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Causes: Infection (filariasis, tuberculosis), injury (trauma, post herniorrhaphy), tumor (malignancy)</li>\n<li>Usually small, lax, and <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> except in cases of <span class=\"customMeta\" data-dictid=\"bcab368ebc169277720239f1f3dfb9\">filariasis</span> where it can be very large</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical Procedure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lord's <span class=\"customMeta\" data-dictid=\"8d378280de169277719566b2898510\">plication</span> - small, thin <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">hydrocele</span> with clear fluid</li>\n<li>Jaboulay's operation - partial <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> removal and eversion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with gynecomastia. Ultrasound reveals a 1 cm solid mass within the body of the testis. Serum testosterone is 600 ng/dL, and estradiol is 35 pg/mL. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Spermatocytic tumor", "correct": false}, {"label": "B", "text": "Sertoli cell tumor", "correct": false}, {"label": "C", "text": "Granulosa cell tumor", "correct": false}, {"label": "D", "text": "Leydig cell tumor", "correct": true}], "correct_answer": "D. Leydig cell tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zzWcJJheyF7b1OdxwyKm1747294844.png", "https://image.prepladder.com/content/W2s6WmuMefzS4VpzIi5K1747294852.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Leydig cell tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sertoli cell tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormonal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It often involves androgens, oestrogens, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormonally silent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conditions associated with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Klinefelter syndrome.</li>\n<li>Cryptorchidism.</li>\n<li>Renal cell carcinoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carney complex.</li>\n<li>Peutz-Jeghers syndrome.</li>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10% (in adults)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Circumscribed nodules, usually &lt; 5 cm in diameter.</li>\n<li>They have a distinctive golden brown, <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> appearance on cut surfaces.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm, small nodules with a homogeneous</p>\n<p>grey-white to yellow cut surface.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells resemble their normal counterparts.</li>\n<li>They are large in size and have <strong>round or polygonal cell outlines</strong>, <strong>abundant</strong> <strong>granular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm</strong>, and a <strong>round central nucleus.</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> frequently contains <strong>lipid droplets</strong>, <strong>vacuoles</strong>, or <strong>lipofuscin</strong> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> and, most characteristically, rod-shaped <strong>Reinke crystalloids</strong> (25% of the tumours).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells are arranged in <strong>distinctive trabeculae</strong> that tend to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>cord-like structures</strong> and <strong>tubules.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"1. Dr. Dharam Ramnani 2. Mikael Haggstrom &amp; Nephron 3. Dr. Roshan Nasimudeen\"' data-hash=\"\" data-license='\"1. Unknown 2. CC BY SA 3.0 3. CC BY SA 4.0\"' data-source='\"1. https://www.webpathology.com/image.asp?case=38&amp;n=4 2. https://commons.wikimedia.org/wiki/File:Call-Exner_bodies.png 3. https://commons.wikimedia.org/wiki/File:Granulosa_cell_tumor_ovary.jpg\"' data-tags=\"\" height=\"398\" src=\"https://image.prepladder.com/content/zzWcJJheyF7b1OdxwyKm1747294844.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://librepathology.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/W2s6WmuMefzS4VpzIi5K1747294852.png\" width=\"417\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with abdominal pain. A CECT (Contrast Enhanced CT) abdomen was done. What is the likely source of pain?", "options": [{"label": "A", "text": "Gall bladder", "correct": false}, {"label": "B", "text": "Spleen", "correct": false}, {"label": "C", "text": "Kidney", "correct": true}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "C. Kidney", "question_images": ["https://image.prepladder.com/content/9OoJWVVxkiiiKZFKT2jR1747298193.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment of RCC: RCCs are radio and chemo-resistant.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">Nephrectomy</span> (Option A): </strong>Involves removing only the tumour while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</li>\n<li><strong>Indications: </strong>Larger tumours or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and Cryoablation </strong>Involve destroying the tumor using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumours (T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following statements regarding Wilms tumor are true, except?", "options": [{"label": "A", "text": "Presents as an abdominal mass", "correct": false}, {"label": "B", "text": "Most commonly seen &amp;lt;5yrs of age", "correct": false}, {"label": "C", "text": "Majority patients recover due to chemotherapy and radiotherapy", "correct": true}, {"label": "D", "text": "Lung involvement in uncommon and occurs late", "correct": false}], "correct_answer": "C. Majority patients recover due to chemotherapy and radiotherapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - Majority patients recover due to &lt;span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\"&gt;chemotherapy&lt;/span&gt; and radioth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "45-year-old female presents with recurrent episodes of right flank pain, hematuria, and a history of urinary tract infections. Urine analysis shows alkaline urine with a pH of 8.0. Microscopy revealed the following finding. Which of the following is the most likely underlying cause of this patient's condition?", "options": [{"label": "A", "text": "Triple phosphate stone", "correct": true}, {"label": "B", "text": "Ca Oxalate Stones", "correct": false}, {"label": "C", "text": "Uric Acid Stones", "correct": false}, {"label": "D", "text": "Cystine Stones", "correct": false}], "correct_answer": "A. Triple phosphate stone", "question_images": ["https://image.prepladder.com/content/mdUOEaloRPLpBcz71nPF1717762441.png"], "explanation_images": ["https://image.prepladder.com/content/iecXbDLrtfZFgomz4Jpd1717762703.png"], "explanation": "<p>Correct Option A - Triple &lt;span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\"&gt;phosphate&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition in the image:", "options": [{"label": "A", "text": "Bulbar urethral stricture", "correct": true}, {"label": "B", "text": "Membranous urethral injury", "correct": false}, {"label": "C", "text": "Urethral tear", "correct": false}, {"label": "D", "text": "Prostate hyperplasia", "correct": false}], "correct_answer": "A. Bulbar urethral stricture", "question_images": ["https://image.prepladder.com/content/tMYKlL4bs8fFJ5JnA7nY1747220356.png"], "explanation_images": ["https://image.prepladder.com/content/nQda5NIGXUZSAO8yrgm91747385090.png", "https://image.prepladder.com/content/Z3hrq0ndEarNQ1AaAxqJ1747220407.png", "https://image.prepladder.com/content/SRllfG8HJJdGvvgZkIxc1747220449.png", "https://image.prepladder.com/content/1WNVCjsw1fvpGPV3I5P21747220457.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"394\" src=\"https://image.prepladder.com/content/SRllfG8HJJdGvvgZkIxc1747220449.png\" width=\"394\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"463\" src=\"https://image.prepladder.com/content/1WNVCjsw1fvpGPV3I5P21747220457.png\" width=\"463\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic fractures (often due to motor vehicle accidents)</strong></li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising <strong>(butterfly-shaped hematoma)</strong></li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Blood at the meatus</strong></li>\n<li><strong>Inability to void</strong></li>\n<li><strong>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</strong></li>\n<li><strong>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</strong></li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: <strong>Gold standard,</strong> shows the extent and location of the injury.</li>\n<li>Voiding Cystourethrography (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU): Gold standard for initial assessment</strong></li>\n<li>CT Urethrography: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Cystoscopy: Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- <strong>Pie in-sky appearance </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient develops a severe infection and necrosis in the scrotal region after 5 days of catheterization. Based on the clinical presentation, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Fournier’s gangrene", "correct": true}, {"label": "B", "text": "Gas gangrene", "correct": false}, {"label": "C", "text": "Wet gangrene", "correct": false}, {"label": "D", "text": "Scrotal hematoma", "correct": false}], "correct_answer": "A. Fournier’s gangrene", "question_images": ["https://image.prepladder.com/content/6XTud23ZOTrsMPbYu7tU1747385439.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Necrotizing infection</strong> of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> Intense pain in the genitalia, progressing through</li>\n</ul>\n<p>five phases:</p>\n<ul>\n<li>\n<ul>\n<li><strong>Prodromal Phase:</strong> Fever and lethargy.</li>\n<li><strong>Early Pain Phase:</strong> Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase:</strong> Increased pain, and erythema.</li>\n<li><strong>Crepitation Phase: </strong>Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase:</strong> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Treatment:</strong>\n<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li><strong>Additional Measures:</strong>\n<ul>\n<li>Urinary and faecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with a painless testicular mass. After orchidectomy, histopathological examination reveals the presence of Reinke's crystals within the tumor cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Sertoli cell tumor", "correct": false}, {"label": "B", "text": "Leydig cell tumor", "correct": true}, {"label": "C", "text": "Seminoma", "correct": false}, {"label": "D", "text": "Yolk sac tumor", "correct": false}], "correct_answer": "B. Leydig cell tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IHMjI4VMwAiVqomRfnds1747222982.png", "https://image.prepladder.com/content/ej57hZFogCCVybJzbm7t1747222991.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Leydig cell tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sertoli cell tumor (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormonal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It often involves androgens, estrogens, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormonally silent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conditions associated with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Klinefelter syndrome.</li>\n<li>Cryptorchidism.</li>\n<li>Renal cell carcinoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carney complex.</li>\n<li>Peutz-Jeghers syndrome.</li>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10% (in adults)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Circumscribed nodules, usually &lt; 5 cm in diameter.</li>\n<li>They have a distinctive golden brown, <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> appearance on cut surfaces.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Firm, small nodules with a homogeneous</li>\n<li>grey-white to yellow cut surface.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells resemble their normal counterparts.</li>\n<li>They are large and have <strong>round or polygonal cell outlines</strong>, <strong>abundant</strong> <strong>granular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm</strong>, and a <strong>round central nucleus.</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> frequently contains <strong>lipid droplets</strong>, <strong>vacuoles</strong>, or <strong>lipofuscin</strong> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> and, most characteristically, rod-shaped <strong>Reinke crystalloids</strong> (25% of the tumors).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells are arranged in <strong>distinctive trabeculae</strong> that tend to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>cord-like structures</strong> and <strong>tubules.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"1. Dr. Dharam Ramnani 2. Mikael Haggstrom &amp; Nephron 3. Dr. Roshan Nasimudeen\"' data-hash=\"\" data-license='\"1. Unknown 2. CC BY SA 3.0 3. CC BY SA 4.0\"' data-source='\"1. https://www.webpathology.com/image.asp?case=38&amp;n=4 2. https://commons.wikimedia.org/wiki/File:Call-Exner_bodies.png 3. https://commons.wikimedia.org/wiki/File:Granulosa_cell_tumor_ovary.jpg\"' data-tags=\"\" height=\"398\" src=\"https://image.prepladder.com/content/IHMjI4VMwAiVqomRfnds1747222982.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://librepathology.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/ej57hZFogCCVybJzbm7t1747222991.png\" width=\"417\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Post-orchidectomy, the specimen shows Reinke's Crystals. What is the diagnosis?", "options": [{"label": "A", "text": "Seminoma", "correct": false}, {"label": "B", "text": "Leydig Cell Tumor", "correct": true}, {"label": "C", "text": "Metastasis", "correct": false}, {"label": "D", "text": "Yolk sac tumour", "correct": false}], "correct_answer": "B. Leydig Cell Tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3ltLnie0ksLODk8fQ9XT1745927980.png", "https://image.prepladder.com/content/DbeykN2w4eoq8fc1Qjql1745927980.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Leydig cell tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sertoli cell tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormonal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It often involves androgens, oestrogens, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormonally silent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conditions associated with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Klinefelter syndrome.</li>\n<li>Cryptorchidism.</li>\n<li>Renal cell carcinoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carney complex.</li>\n<li>Peutz-Jeghers syndrome.</li>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10% (in adults)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Circumscribed nodules, usually &lt; 5 cm in diameter.</li>\n<li>They have a distinctive golden brown, <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> appearance on cut surfaces.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm, small nodules with a homogeneous</p>\n<p>grey-white to yellow cut surface.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells resemble their normal counterparts.</li>\n<li>They are large in size and have <strong>round or polygonal cell outlines</strong>, <strong>abundant</strong> <strong>granular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm</strong>, and a <strong>round central nucleus.</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> frequently contains <strong>lipid droplets</strong>, <strong>vacuoles</strong>, or <strong>lipofuscin</strong> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> and, most characteristically, rod-shaped <strong>Reinke crystalloids</strong> (25% of the tumours).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells are arranged in <strong>distinctive trabeculae</strong> that tend to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>cord-like structures</strong> and <strong>tubules.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mikael Häggström, M.D.\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://en.wikipedia.org/wiki/Leydig_cell_tumour#/media/File:Histopathology_of_leydig_cell_tumor_of_the_ovary,_high_mag,_annotated.png\" data-tags=\"\" height=\"285\" src=\"https://image.prepladder.com/content/3ltLnie0ksLODk8fQ9XT1745927980.png\" width=\"329\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://librepathology.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/content/DbeykN2w4eoq8fc1Qjql1745927980.png\" width=\"401\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 year old patient with a history of kidney stones that were surgically removed 2 years ago presents with complaints of fever and flank pain. Imaging done is shown here. What would be the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Laparotomy to remove the stones", "correct": false}, {"label": "B", "text": "Lithotripsy to remove recurrent stone", "correct": false}, {"label": "C", "text": "Leave the foreign body inside", "correct": false}, {"label": "D", "text": "Cystoscopic retrieval of foreign Body", "correct": true}], "correct_answer": "D. Cystoscopic retrieval of foreign Body", "question_images": ["https://image.prepladder.com/content/1fxPJEztudIvlF4rPrCw1698985337.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\"&gt;Cystoscopic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cbe99c8c751692777197bc9fcb503b\"&gt;retrieval&lt;/span&gt; of foreign B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presents with urinary complaints. He has a history of working in a dye factory in the past. On USG examination, his bladder walls are found to be thickened and irregular. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Instillation of BCG", "correct": false}, {"label": "B", "text": "Cystoscopy with tumor removal", "correct": false}, {"label": "C", "text": "Intravesical mitomycin C", "correct": false}, {"label": "D", "text": "Radical cystectomy", "correct": true}], "correct_answer": "D. Radical cystectomy", "question_images": ["https://image.prepladder.com/content/fv0eH683GOMJfoowy53h1692689157.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Radical C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the best investigation to assess renal perfusion?", "options": [{"label": "A", "text": "DTPA scan", "correct": true}, {"label": "B", "text": "DMSA scan", "correct": false}, {"label": "C", "text": "RGU", "correct": false}, {"label": "D", "text": "CT urogram", "correct": false}], "correct_answer": "A. DTPA scan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"6497d3860316927771867148ec55df\"&gt;DTPA&lt;/span&gt; (diethylenetriaminepentaacetic acid)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child is brought to the emergency department with a painless mass in the abdomen. Upon examination, a large mobile abdominal mass is noted, and it does not cross the midline. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Neuroblastoma", "correct": false}, {"label": "B", "text": "Angiomyolipoma", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": false}, {"label": "D", "text": "Wilm’s tumor", "correct": true}], "correct_answer": "D. Wilm’s tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Wilm’s tu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"8cafee27cd1692777193f90f913651\">Nephroblastoma</span> (Wilms tumor):</strong></p>\n<ul>\n<li>It is a rare <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> cancer that mainly affects children.</li>\n<li>Hematogenous spread.</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> to lung.</li>\n<li>Treatment by <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> followed by surgery.</li>\n<li>It most often affects children ages 3 to 4.</li>\n<li>Nephroblastoma is a <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> or cancerous tumor that originates in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> cells.</li>\n<li>Symptoms of Nephroblastoma:\n\t\t\t\t<ul style=\"list-style-type:circle\">\n<li>A mass in the stomach area that can be felt.</li>\n<li>Swelling in the stomach area.</li>\n<li>Pain in the stomach area.</li>\n<li>Fever.</li>\n<li>Blood in the urine.</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> level, also known as anemia.</li>\n<li>High blood pressure.</li>\n</ul>\n</li>\n</ul>\n<p><strong>2. Stages of Nephroblastoma:</strong></p>\n<ul>\n<li>Stage I indicates the tumor was completely contained within the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> without any breaks or spillage outside the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> and no <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> invasion. This stage accounts for 40% to 45% of all Wilms tumors.</li>\n<li>Stage II would be a tumor that has grown outside the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> to some degree, such as into surrounding <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> tissue. Usually, the tumor would be completely removable by surgery, and regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes are negative. About 20% of all Wilms tumors are at this stage.</li>\n<li>Stage III comprises about 20% to 25% of all Wilms tumors and indicates a tumor which could not be completely removed surgically such as the following:\n\t\t\t\t<ul style=\"list-style-type:circle\">\n<li>Cancer has spread to the regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes but not to more distant nodes, such as in the chest</li>\n<li>Cancer has grown into nearby vital structures so it could not be surgically removed completely</li>\n<li>Deposits of the tumor (tumor implants) are found in the peritoneum, or there are positive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> margins</li>\n<li>Cancer cells were accidentally “spilled” into the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> during surgery</li>\n<li>The tumor was removed in separate pieces surgically; such as one piece from the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> and another from the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> gland</li>\n<li>A <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumor was done before it was surgically removed.</li>\n</ul>\n</li>\n<li>Stage IV tumors are those that have spread through the <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> system to distant organs such as the lungs, liver, brain, or bones, or to distant <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes. These account for about 10% of all Wilms tumors.</li>\n<li>Stage V are those cases where both kidneys are involved with tumor at the time of initial diagnosis. About 5% of all Wilms tumors are at this stage. Individual <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> of each <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> unit is needed as well.</li>\n</ul>\n<p><strong>3. Treatments of Nephroblastoma:</strong></p>\n<ul>\n<li>Wilms tumor is chemosensitive.</li>\n<li>Treatment of <span class=\"customMeta\" data-dictid=\"8b8f271ea516927772024ef17cdb69\">Wilms tumor</span> is usually <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> followed by <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> chemotherapy, but some protocols initiate <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> first and do the <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> later.</li>\n<li>The opposite <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> may be explored to ensure that cancer has not spread, although this is unnecessary for low-stage tumors with favorable <span class=\"customMeta\" data-dictid=\"ebf8f256f3169277718992ac1b2330\">histology</span> if <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> is negative.</li>\n<li>Lymph nodes around the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> are sampled for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> and to improve survival.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with complaints of dysuria and intermittent back pain. On examination, there are no palpable abdominal masses or tenderness. An X-ray image of the abdomen is shown. What is the most likely diagnosis?", "options": [{"label": "A", "text": "PTH adenoma", "correct": true}, {"label": "B", "text": "Wilm's tumour", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": false}, {"label": "D", "text": "Lipoma", "correct": false}], "correct_answer": "A. PTH adenoma", "question_images": ["https://image.prepladder.com/content/pOXIVHkqdT8A8zaZypYG1745932384.png"], "explanation_images": ["https://image.prepladder.com/content/icMORvb1gqRDhihpEA1c1744982618.png", "https://image.prepladder.com/content/wgqJEugI2QjkyB0m9lXu1744982624.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Manifestations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal system (stones) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypercalciuria</li>\n<li>Nephrocalcinosis</li>\n<li>Nephrolithiasis</li>\n<li>Polydipsia, polyuria, nocturia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excretion of <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium</li>\n<li>Calcium deposition in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> parenchyma</li>\n<li>Precipitation of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> with <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> or oxalate</li>\n<li>Inhibition of <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> due to ↑ <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skeletal system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteoporosis</li>\n<li>Subperiosteal resorption(radial aspect)</li>\n<li>Tufting of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> phalanx</li>\n<li>Brown tumour/ <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> fibrosa cystica</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Brown_tumor\" data-tags=\"\" height=\"430\" src=\"https://image.prepladder.com/content/icMORvb1gqRDhihpEA1c1744982618.png\" width=\"450\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Salt and pepper skull</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"haitham alfalah\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pepper_%26_Salt.JPG\" data-tags=\"\" height=\"298\" src=\"https://image.prepladder.com/content/wgqJEugI2QjkyB0m9lXu1744982624.png\" width=\"450\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Chondrocalcinosis</li>\n<li>Pseudo gout</li>\n<li>Joint pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium resorption</li>\n<li>Deposition of <span class=\"customMeta\" data-dictid=\"244b573f9d169277718887b033ba57\">hemosiderin</span> in the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdomen </strong></p>\n<p><strong>(abdominal groans)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Constipation</li>\n<li>Peptic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> groans</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inhibitory effect of <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> on <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> (GI) smooth muscle contraction.</li>\n<li>Spasm of sphincters</li>\n<li>Increased gastrin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CNS</strong></p>\n<p><strong>(psychiatric moans)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confusion</li>\n<li>Anxiety</li>\n<li>Depression</li>\n<li>Psychosis: <span class=\"customMeta\" data-dictid=\"31e024808f169277719632c7d01b89\">psychic</span> moans</li>\n<li>Some mild memory loss</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Depression of the nervous system</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscular system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness</li>\n<li>Fatigue overtones</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased muscle activity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presented with verrucous carcinoma around the glans of the penis. Examination reveals that the inguinal lymph nodes are not enlarged. What is the appropriate management for this patient?", "options": [{"label": "A", "text": "Total penectomy", "correct": false}, {"label": "B", "text": "CO2 laser excision", "correct": false}, {"label": "C", "text": "Topical 5-fluorouracil", "correct": false}, {"label": "D", "text": "Partial penectomy", "correct": true}], "correct_answer": "D. Partial penectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cancer Type/Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Localized Tumor - <span class=\"customMeta\" data-dictid=\"e62ab50e7a16927771882c6a886b18\">Glans</span> Only</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Partial penectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Distal Penile Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"9511f3dca216927771953e33166404\">penectomy</span> with 2cm margin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Proximal Penile Involvement</strong></p>\n<p><strong>/Anaplastic Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Total penectomy</strong> with <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> urethrostomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Carcinoma in situ, T1 Lesions, Well-Differentiated Tumors in Young </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Circumcision followed by <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> radiotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"108e66d0571692777189ff4a5e8740\">ilioinguinal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Advanced Disease - T2 or Poorly Differentiated Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prophylactic inguinal nodal dissection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Carcinoma in situ</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Topical treatments (<strong>5-FU cream</strong>, imiquimod), Mohs surgery, <strong>laser therapy</strong>, or limited excision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Combination <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> (5-FU, methotrexate, bleomycin, cisplatin, vincristine)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p>Stage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p>Description</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>TX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Primary tumours cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No evidence of a primary tumour</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (Penile <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> neoplasia, PeIN)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Noninvasive localised <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria, dermis, or <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue with/without lymphovascular or <span class=\"customMeta\" data-dictid=\"849a50eb4a1692777195de19bee5ed\">perineural</span> invasion</p>\n<ul>\n<li>T1a: without invasion/high grade</li>\n<li>T1b: with invasion/high grade</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> spongiosum with or without urethral invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"8c62bbe6721692777185d6892c1f31\">corpora</span> cavernosa with or without urethral invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades adjacent structures (e.g., prostate, scrotum, <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cNX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Regional nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> or visible enlarged inguinal nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Palpable mobile <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Palpable mobile <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> ≥2 inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Palpable fixed inguinal nodal mass or <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> (unilateral or bilateral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cM0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No distant metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cM1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Distant metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>pM1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> microscopically confirmed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient presents with sudden-onset perineal pain. On examination, foul-smelling discharge and necrotic tissue, as seen in the image, are noted. Which of the following is true about the given condition?", "options": [{"label": "A", "text": "Anti-gas gangrene serum is indicated for all cases", "correct": false}, {"label": "B", "text": "Urinary diversion is the next step", "correct": false}, {"label": "C", "text": "A bilateral orchidectomy must be done", "correct": false}, {"label": "D", "text": "Mixed aerobic and anaerobic infection", "correct": true}], "correct_answer": "D. Mixed aerobic and anaerobic infection", "question_images": ["https://image.prepladder.com/notes/dMm6WwIc4a74v2T8Jo3U1745916336.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Necrotizing infection</strong> of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li><strong>Prodromal Phase:</strong> Fever and lethargy.</li>\n<li><strong>Early Pain Phase:</strong> Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase:</strong> Increased pain and erythema.</li>\n<li><strong>Crepitation Phase: </strong>Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase:</strong> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Treatment:</strong>\n<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li><strong>Additional Measures:</strong>\n<ul>\n<li>Urinary and faecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true regarding the provided medical condition?", "options": [{"label": "A", "text": "Repeated radical surgery every 24 hours may be required to adequately manage this condition", "correct": false}, {"label": "B", "text": "This is a case of Meleney's gangrene", "correct": false}, {"label": "C", "text": "The condition is caused by β-hemolytic streptococcus and may sometimes be polymicrobial", "correct": false}, {"label": "D", "text": "Hyperbaric oxygen has no role in the treatment of this condition.", "correct": true}], "correct_answer": "D. Hyperbaric oxygen has no role in the treatment of this condition.", "question_images": ["https://image.prepladder.com/notes/IBD0eZHYvrInI3YX8Rox1745916344.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male patient presents with hematuria and a neovascular mass in the left kidney on a CT scan, as shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Renal cell carcinoma", "correct": false}, {"label": "B", "text": "Renal oncocytoma", "correct": false}, {"label": "C", "text": "Renal angiomyolipoma", "correct": true}, {"label": "D", "text": "Renal cyst", "correct": false}], "correct_answer": "C. Renal angiomyolipoma", "question_images": ["https://image.prepladder.com/notes/HUENQEUgV7saPSLCrxGj1747380820.png"], "explanation_images": ["https://image.prepladder.com/content/hXQ2vAmkDvUdMNfnhxif1746164419.png", "https://image.prepladder.com/content/z1aAr2Oo3qIjMxTU4MgD1746164419.png", "https://image.prepladder.com/content/OojTd3aL8Z5QMoDtbnxp1746164419.png", "https://image.prepladder.com/content/HtFkc5XSYTQEIBYWb4Im1746164419.png", "https://image.prepladder.com/content/LbciG75vH6kk7iGap2yd1746164419.png", "https://image.prepladder.com/content/5EVW2hUzVGiUfzPKv7gV1746164419.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Arise from</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Perivascular <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Types</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Sporadic AMLs:</strong> Present in the 4th-6th decades, typically small, solitary, and slow-growing.</li>\n<li><strong>TSC-associated AMLs: </strong>Present earlier (3rd-4th decades), larger, multiple, bilateral, and tend to grow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Abdominal or <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> pain, hematuria, hypertension, anemia.</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function, usually due to <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (severe complication).</li>\n<li><strong>Wunderlich syndrome</strong>: Nontraumatic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> hemorrhage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Risk Factors for AML Complications</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Pregnancy: </strong>Increased risk of hemorrhage</li>\n<li><strong>TSC-associated AMLs:</strong> Higher risk of CKD and ESKD</li>\n<li><strong>Epithelioid AMLs:</strong> Potential for <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation, metastasis, and local recurrence.</li>\n</ul>\n<p> </p>\n<p><strong>Risk factors for hemorrhage:</strong></p>\n<ul>\n<li>AML size (&gt;6 cm)</li>\n<li>Increased vascularity</li>\n<li>Large <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> aneurysms (&gt;5 mm)</li>\n<li>Exophytic growth pattern.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Histology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Circular blood vessels, muscles, and fat; <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells with dense <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> and mitotic figures.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"No machine-readable author provided. KGH assumed (based on copyright claims).,\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Renal_angiomyolipoma_(1).jpg\" data-tags=\"\" height=\"514\" src=\"https://image.prepladder.com/content/hXQ2vAmkDvUdMNfnhxif1746164419.png\" width=\"677\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td rowspan=\"9\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>CT: (Investigation of choice) </strong>Presence of <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> fat and <span class=\"customMeta\" data-dictid=\"624c00049d1692777193b1a9d81379\">neovascular</span> mass.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Angiomyolipoma#/media/File:Angiomyolipome_der_Niere_CT.jpg\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/content/z1aAr2Oo3qIjMxTU4MgD1746164419.png\" width=\"741\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>USG: </strong>Appears as hyperechoic</li>\n<li><strong>Immunocytochemical analysis: </strong>Differentiates AML from RCC, using markers like HMB-45 and melan-A<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Observation (tumors &lt;4 cm)</li>\n<li>Nephron-Sparing Surgery(Partial nephrectomy) (larger tumors or those with a high risk of bleeding)</li>\n<li>Angioembolization (acute hemorrhage).</li>\n<li>Medications (mTOR inhibitors like <span class=\"customMeta\" data-dictid=\"aa8d032496169277718724299fb4cb\">everolimus</span> and sirolimus).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which lymph node is most commonly involved in prostate cancer?", "options": [{"label": "A", "text": "Deep inguinal", "correct": false}, {"label": "B", "text": "Retroperitoneal", "correct": false}, {"label": "C", "text": "Superficial inguinal", "correct": false}, {"label": "D", "text": "Pelvic", "correct": true}], "correct_answer": "D. Pelvic", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumor in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> over the age of 65 years.</li>\n<li>Most common among Afro-American</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Advanced age</li>\n<li>High-fat diet</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protective factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(Mnemonic: LESA)</strong></p>\n<ul>\n<li><strong>L</strong>ycopene</li>\n<li>Vitamin <strong>E</strong></li>\n<li><strong>S</strong>elenium</li>\n<li>Vitamin <strong>A</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common site- <strong>peripheral zone (75%)</strong> &gt; <span class=\"customMeta\" data-dictid=\"1ef284d05a169277720146906d01cb\">transitional zone</span> (15%) &gt; central zone (10%)</li>\n<li>Most common <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> type is <strong>adenocarcinoma</strong></li>\n<li>Most common genetic alteration seen in CA prostate- <strong>hypermethylation of GSTP1 </strong>(Glutathione <span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\">transferase</span> <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> region 1) located on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11.</li>\n<li>70-80% of the cases.</li>\n<li>Microscopy: small, crowded, absent <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> layer, lack of branching</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Commonly asymptomatic.</li>\n<li>Bladder outlet obstruction.</li>\n<li>Haematuria</li>\n<li>Pelvic pain, back pain, <span class=\"customMeta\" data-dictid=\"2b0ec4bfad1692777182bbd41fc010\">arthritic</span> pain in <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint-features of secondaries</li>\n<li>On per rectal examination: hard, nodular, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> often with loss of <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> groove.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Routes of spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common route of spread- <strong>haematogenous</strong> (skeletal metastases: <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> bones and the lower <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae)</li>\n<li><strong>Lymphatic: </strong>Internal iliac, external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> nodes and occasionally the <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>DRE (Digital Rectal Exam): </strong>Physical examination; detects nodules but limited in early-stage</li>\n<li><strong>PSA (prostate-specific antigen) Test: </strong>Measures <span class=\"customMeta\" data-dictid=\"9a70998c381692777196f5daf6edb1\">PSA</span> levels; elevated levels suggest cancer</li>\n<li><strong>TRUS (Transrectal Ultrasound): </strong>Imaging with rectal probe; detects abnormalities</li>\n<li><strong>mpMRI (Multiparametric MRI): </strong>Advanced imaging; superior for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> and capsular spread</li>\n<li><strong>Prostate Biopsy: </strong>Gold standard for diagnosis; tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> for cancer cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Active Surveillance: </strong>For low-risk cases; regular monitoring</li>\n<li><strong>Radical Prostatectomy: </strong>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</li>\n<li><strong>Radiation Therapy: </strong>High-energy rays; external or brachytherapy</li>\n<li><strong>Hormone Therapy: </strong>Reduces/block testosterone; for advanced/metastatic cases</li>\n<li><strong>Chemotherapy: </strong>Systemic drug treatment; for advanced/metastatic cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false about the following image?", "options": [{"label": "A", "text": "Staphylococcus aureus is the causative organism", "correct": true}, {"label": "B", "text": "Common in diabetic patients", "correct": false}, {"label": "C", "text": "High mortality", "correct": false}, {"label": "D", "text": "The testes remain unaffected", "correct": false}], "correct_answer": "A. Staphylococcus aureus is the causative organism", "question_images": ["https://image.prepladder.com/notes/TSNHX377XxwownoRJm6R1747381244.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Necrotizing infection of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mixed infection of <span class=\"customMeta\" data-dictid=\"789c9dd31a16927771801dd2426384\">aerobic</span> and <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> bacteria in a fulminating <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms: Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li><strong>Prodromal Phase: </strong>Fever and lethargy.</li>\n<li><strong>Early Pain Phase:</strong> Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase: </strong>Increased pain, erythema.</li>\n<li><strong>Crepitation Phase: </strong>Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase: </strong>Gangrene with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n<li>Diabetes mellitus <strong>(Option B ruled out)</strong></li>\n<li>Malnutrition</li>\n<li>Alcoholism</li>\n<li>Immunocompromised states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n<p><strong>Additional Measures:</strong></p>\n<ul>\n<li>Daily rounds (high rates mortality and morbidity) <strong>(Option C ruled out)</strong></li>\n<li>Urinary and fecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of hernia is a funicular hernia? Direct inguinal hernia", "options": [{"label": "A", "text": "Direct inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Umbilical hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s6V3IqtzvKmt9oZsIHrC1746167265.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through Hesselbach's triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">Processus</span> vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> <strong>(Option B)</strong></li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Indirect inguinal hernia</p>\n<ul>\n<li>Normal internal inguinal ring\n\t\t\t\t<ul>\n<li>e.g., <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> hernia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indirect inguinal hernia</strong></p>\n<ul>\n<li>Dilated internal inguinal ring</li>\n<li>Posterior inguinal wall intact</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A: </strong>Direct inguinal hernia</p>\n<p><strong>B: </strong>Indirect inguinal hernia</p>\n<ul>\n<li>Internal inguinal ring dilated</li>\n<li>Encroaching medially or destroying the <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> of the Hesselbach <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (e.g. scrotal sliding or pantaloon hernia)</li>\n</ul>\n<p><strong>C: </strong>Femoral hernia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV (Recurrent Hernia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A: </strong>Direct</p>\n<p><strong>B</strong>: Indirect</p>\n<p><strong>C: </strong>Femoral</p>\n<p><strong>D: </strong>Combined</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient came to the outpatient department with complaints of hematuria. A 2x2 cm bladder mass is seen which is low-grade transitional cell carcinoma. Which among the following is the ideal management?", "options": [{"label": "A", "text": "Transurethral resection of the tumor", "correct": true}, {"label": "B", "text": "Resection with ileal conduit", "correct": false}, {"label": "C", "text": "Partial cystectomy with bladder reconstruction", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy", "correct": false}], "correct_answer": "A. Transurethral resection of the tumor", "question_images": ["https://image.prepladder.com/notes/k5feFp2x6mCLTdcS65LK1747381598.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Tumor Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Tis (Carcinoma in situ)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT (Transurethral <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Tumor)</strong></p>\n<ul>\n<li>May be used for initial diagnosis and tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> if not already performed</li>\n</ul>\n<p><strong>Intravesical BCG</strong></p>\n<ul>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Weekly for 3 weeks at months 3, 6, 12, 18, 24, 30, and 36</li>\n</ul>\n<p><strong>Continue BCG Maintenance Therapy</strong></p>\n<ul>\n<li>Up to 3 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ta (Non-muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong></p>\n<ul>\n<li>Complete <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of tumor</li>\n</ul>\n<p><strong>Low-risk:</strong></p>\n<ul>\n<li>Single Instillation (SI) of Intravesical <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine, mitomycin)</li>\n<li>SI within 24 hours of TURBT</li>\n<li>Alternative: Continuous <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> irrigation</li>\n</ul>\n<p><strong>Intermediate-risk:</strong></p>\n<ul>\n<li>Intravesical <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine)</li>\n<li>Induction: 6 weekly courses</li>\n<li>Maintenance: Up to 1 year</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T1 (Muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong>- For initial diagnosis and tumor debulking</p>\n<p><strong>High-risk:</strong></p>\n<ul>\n<li>Intravesical BCG</li>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Up to 3 years</li>\n</ul>\n<p><strong>Consider Cystectomy</strong></p>\n<ul>\n<li>If BCG is not tolerated or ineffective- Alternative: Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T2 (Muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong>- May be used for tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and staging</p>\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Consider Cystectomy</li>\n<li>Alternatively, Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Depending on response and tumor characteristics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T3 (Advanced muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy with possible <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> chemotherapy</li>\n</ul>\n<p><strong>TURBT </strong>- Often not performed if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> is planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Based on <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> and staging</li>\n<li>Neoadjuvant therapy may continue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T4 (Locally advanced)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy</li>\n<li>Neoadjuvant Chemotherapy, if not yet administered</li>\n</ul>\n<p><strong>TURBT</strong>- Typically avoided if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> and <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> therapy are planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Additional <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or radiation based on <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> disease and staging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following will have unilateral hydronephrosis?", "options": [{"label": "A", "text": "Urethral atresia", "correct": false}, {"label": "B", "text": "Posterior urethral valves", "correct": false}, {"label": "C", "text": "Benign Prostatic Hyperplasia", "correct": false}, {"label": "D", "text": "Retrocaval ureter", "correct": true}], "correct_answer": "D. Retrocaval ureter", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Unilateral Hydronephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bilateral Hydronephrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extramural Causes:</strong></p>\n<ul>\n<li>Advanced Malignancies\n\t\t\t\t<ul>\n<li>Colorectal cancer</li>\n<li>Carcinoma cervix</li>\n<li>Carcinoma Prostate</li>\n</ul>\n</li>\n<li>Retroperitoneal fibrosis</li>\n<li>Retrocaval Ureter<strong> (Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital Causes:</strong></p>\n<ul>\n<li>Posterior Urethral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> <strong>(Option B ruled out)</strong></li>\n<li>Urethral <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intramural Causes:</strong></p>\n<ul>\n<li>PUJ Obstruction</li>\n<li>Ureterocele</li>\n<li>Ureteric Stricture</li>\n<li>Urothelial tumor</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired Causes:</strong></p>\n<ul>\n<li>Bladder neck stenosis</li>\n<li>BPH (Benign Prostatic Hyperplasia) <strong>(Option C ruled out)</strong></li>\n<li>CA Prostate</li>\n<li>Urethral strictures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intraluminal Causes:</strong></p>\n<ul>\n<li>Stone</li>\n<li>Papillary Slough</li>\n<li>Due to:\n\t\t\t\t<ul>\n<li>Analgesic nephropathy</li>\n<li>Sickle cell anemia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Unilateral Hydronephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bilateral Hydronephrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Congenital PUJ obstruction</strong> and <strong>calculus </strong>are the most common causes</li>\n<li>Male to Female ratio 2:1</li>\n<li>Right side <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> is affected more commonly</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>From lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction:</strong></p>\n<ul>\n<li>Loin pain</li>\n<li>Features of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet obstruction—frequency, hesitancy, poor stream</li>\n<li>Kidneys are not <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> if <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure develops early</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dull aching <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> pain with dragging sensation or heaviness</li>\n<li>Mass in the <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> which moves with respiration</li>\n<li><strong>Dietl's crisis (Intermittent Hydronephrosis)</strong>: <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> in the <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> after <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> colic, disappears after passing a large volume of urine<strong> </strong></li>\n<li>Dysuria, haematuria. If infected, fever and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> angle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>From <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction:</strong></p>\n<ul>\n<li>Loin pain, mass in the loin, attacks of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> colic</li>\n<li>In severe cases, features of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure like oliguria, edema, and hiccoughs may be present</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 44-year-old lady presents to the hospital with a ballotable flank mass. The mass measures 4 cm on CT imaging. Urine examination shows malignant cells. What is the most appropriate management for her condition?", "options": [{"label": "A", "text": "Partial nephrectomy", "correct": true}, {"label": "B", "text": "Partial nephrectomy + Neoadjuvant chemotherapy", "correct": false}, {"label": "C", "text": "Radical nephrectomy", "correct": false}, {"label": "D", "text": "Radical nephrectomy + Postoperative radiotherapy", "correct": false}], "correct_answer": "A. Partial nephrectomy", "question_images": ["https://image.prepladder.com/content/GeUNOVN7WBBJNM5pi8cH1746167730.png"], "explanation_images": ["https://image.prepladder.com/content/bJS2CD1qtIab88QC9ZeA1746167775.png", "https://image.prepladder.com/content/FmaAcUaaJ1QIUDe3cleh1746167788.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">RCCs are radio and chemo-resistant.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial Nephrectomy: </strong>Involves removing only the tumor while preserving the remainder of the kidney. <strong>(Option A)</strong></p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim. <strong>(Option C ruled out)</strong></p>\n<p><strong>Indications: </strong>Larger tumors or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and Cryoablation: </strong>Involve destroying the tumor using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumors(T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the recommended treatment for the condition shown in the image, where the size of the stone is 1.5 cm?", "options": [{"label": "A", "text": "Percutaneous nephrolithotomy", "correct": false}, {"label": "B", "text": "Ureteroscopy", "correct": true}, {"label": "C", "text": "ESWL", "correct": false}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "B. Ureteroscopy", "question_images": ["https://image.prepladder.com/notes/LK02IRYkyb6AHbHgCvIs1747407623.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial management approach for urinary symptoms in a patient with benign prostatic hyperplasia (BPH)?", "options": [{"label": "A", "text": "TURP: Transurethral resection of prostate", "correct": false}, {"label": "B", "text": "Tamsulosin", "correct": true}, {"label": "C", "text": "Finasteride", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Tamsulosin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>1st line management: ⍺ 1 <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">Blocker</span> </strong>\n<ul>\n<li>Prazosin</li>\n<li>Terazosin</li>\n<li>Silodosin</li>\n<li>Most commonly used:<strong> Tamsulosin</strong> (⍺ 1A selective Blocker) <strong>(Option B)</strong></li>\n</ul>\n</li>\n<li><strong>2nd line: 5 𝛼 <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">Reductase</span> inhibitors</strong>\n<ul>\n<li>Finasteride <strong>(Option C ruled out)</strong></li>\n<li>Dutasteride</li>\n<li>Triptorelin pamoate</li>\n</ul>\n</li>\n<li>Combination treatment with <strong> </strong>⍺ 1 <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">Blocker</span> and 5 𝛼 <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">Reductase</span> inhibitors are used in large prostate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Indications: </strong>\n<ul>\n<li>No improvement in medical management.</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of urine</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> with <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> of more than 200 ml.</li>\n<li>Complications like hydroureter, hydronephrosis, stone formation, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infection, and gross haematuria</li>\n</ul>\n</li>\n<li><strong>Surgeries: </strong>\n<ul>\n<li><strong>Gold standard- TURP</strong> (Trans urethral <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of prostate). <strong>(Option A ruled out)</strong></li>\n<li>Trans urethral <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> of <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> (TUIP)</li>\n<li>Open <span class=\"customMeta\" data-dictid=\"4f419067a61692777196c1039e5eb3\">prostatectomy</span> procedures</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Benign prostatic <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (BPH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Role of hormones in BPH:</strong>\n<ul>\n<li><strong>DHT (Dihydrotestosterone)</strong>\n<ul>\n<li>DHT, derived from <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> via 5-alpha reductase, binds to <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> receptors in the prostate, promoting <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and contributing to prostatic enlargement.</li>\n</ul>\n</li>\n<li><strong>Estrogen</strong>\n<ul>\n<li>Estrogen levels increase relative to <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> in <span class=\"customMeta\" data-dictid=\"c13872f9e3169277718001d2a0f063\">aging</span> men, influencing <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> growth through <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors, particularly ER-α, in the prostatic tissue.</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>Affects both <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> to variable degrees.</li>\n<li><strong>Most common site of origin:</strong> <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> glands of <span class=\"customMeta\" data-dictid=\"9f0c1a99081692777195efa0fd76d0\">periurethral</span> <strong>transitional zone </strong></li>\n<li>Secondary changes in the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (due to increased force of <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of <span class=\"customMeta\" data-dictid=\"80d318a6701692777186805934d86a\">detrusor</span> muscles):\n\t\t\t\t<ul>\n<li>Collagen deposition</li>\n<li>Detrusor muscle hyperplasia</li>\n<li>Detrusor muscle hypertrophy.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age affected: <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">Men</span> over 50 years</li>\n<li>Common cause of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (BOO) in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> more than 70 years of age: BPH</li>\n<li><strong>Obstructive symptoms:</strong>\n<ul>\n<li>Poor flow/stream</li>\n<li>Hesitancy</li>\n<li>Intermittency</li>\n<li>Incomplete voiding-High post-void <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> urine</li>\n<li>Dribbling of urine</li>\n</ul>\n</li>\n<li><strong>Irritative symptoms:</strong>\n<ul>\n<li>Frequency</li>\n<li>Urgency</li>\n<li>Nocturia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> and C/S.</li>\n<li>Ultrasound abdomen- <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> size.</li>\n<li><strong>Uroflowmetry (Qmax):</strong>\n<ul>\n<li>Normal: &gt; 15 ml/sec.</li>\n<li>Equivocal: 10-15 ml.</li>\n<li>Low: &lt;10 ml</li>\n</ul>\n</li>\n<li><strong>Cystometry:</strong>\n<ul>\n<li>Voiding pressure</li>\n<li>Normal: &lt;60 cm of H₂O</li>\n<li>Equivocal: 60- 80 cm of H₂O</li>\n<li>High: &gt;80 cm of H₂O</li>\n</ul>\n</li>\n<li>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Retention</li>\n<li>Haematuria</li>\n<li>Urinary infection</li>\n<li>Stone formation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are true about nephroblastoma except:", "options": [{"label": "A", "text": "Treatment is chemotherapy followed by surgery", "correct": false}, {"label": "B", "text": "Lung metastasis is common", "correct": false}, {"label": "C", "text": "Hematogenous spread", "correct": false}, {"label": "D", "text": "Most common intra-abdominal malignancy in children", "correct": true}], "correct_answer": "D. Most common intra-abdominal malignancy in children", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Caused by mutations in WT1 and WT2 genes on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated syndromes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Denys-Drash Syndrome (DDS): </strong>A rare genetic disorder caused by mutations in the WT1 gene, characterized by a <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of Wilms' tumor, <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome due to <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> mesangial sclerosis, and male pseudohermaphroditism</li>\n<li><strong>WAGR Syndrome: </strong>A rare genetic condition caused by a <span class=\"customMeta\" data-dictid=\"cf1e8ec6121692777185eba2630061\">deletion</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11p13, leading to a combination of Wilms' tumor, <span class=\"customMeta\" data-dictid=\"6f7ae5c0d01692777181fda74da32a\">aniridia</span> (absence of the iris), <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> abnormalities, and intellectual disability.</li>\n<li><strong>Beckwith-Wiedemann Syndrome (BWS): </strong>A genetic disorder characterized by overgrowth, increased tumor risk, macroglossia, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall defects, and hemihyperplasia, often due to abnormalities on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11p15.5.</li>\n<li><strong>Perlman Syndrome: </strong>A rare genetic disorder characterized by overgrowth, developmental delay, intellectual disability, distinctive <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> features, and an increased risk of Wilms' tumor, often caused by mutations in the DIS3L2 gene.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tumor.</li>\n</ul>\n<p><strong>Triad:</strong></p>\n<ul>\n<li>Asymptomatic <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass <strong>(MC presentation)</strong></li>\n<li>Fever (disappears after tumor resection)</li>\n<li>Hematuria (Gross/Microscopic)</li>\n</ul>\n<p><strong>Rarely</strong>: Pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>USG- </strong>Primary investigation</p>\n<p><strong>CECT- Investigation of choice.</strong></p>\n<p><strong>MRI - </strong>For better soft tissue visualization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemotherapy followed by surgery.<strong> (Option A ruled out)</strong></p>\n<p><strong>Multimodal approach</strong></p>\n<ul>\n<li><strong>Surgery</strong>: Radical <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> or nephron-sparing surgery</li>\n</ul>\n<ul>\n<li><strong>Chemotherapy</strong>: <strong>VCD <span class=\"customMeta\" data-dictid=\"988bd8e7c71692777197b9f1d5d5ca\">regimen</span> </strong></li>\n</ul>\n<p>Vincristine, Cyclophosphamide, Dactinomycin/Doxorubicin</p>\n<ul>\n<li><strong>Radiation therapy</strong>: For higher stages or unfavorable histology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I.</strong> Disease confined to the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> and completely resectable</p>\n<p><strong>II</strong>. Tumor extends beyond the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> but can be excised completely</p>\n<p><strong>Ill</strong>. <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> disease after <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> with positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and massive spillage</p>\n<p><strong>IV</strong>. Blood-borne metastasis</p>\n<p><strong>V</strong>. <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most important <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">Prognostic</span> Factor - <strong>Histology &gt; Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mainly through a <strong>hematogenous route </strong>into: <strong> (Option C ruled out)</strong></p>\n<ul>\n<li>Lungs (MC)<strong> (Option B ruled out)</strong></li>\n<li>Liver</li>\n<li>Bones (Rarely)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient presents to the surgical OPD with a painless left inguinal reducible mass. On examination cough impulse is positive. After further investigations, the patient is diagnosed with an inguinal hernia. What is the surgical management of this patient?", "options": [{"label": "A", "text": "Herniotomy", "correct": false}, {"label": "B", "text": "Hernioplasty", "correct": true}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "Emergency laparotomy", "correct": false}], "correct_answer": "B. Hernioplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Fxto3T31GOkxsTgEagXS1746169975.png", "https://image.prepladder.com/content/IsDW33cb5VsEpbIY1L8W1746169975.png", "https://image.prepladder.com/content/KgxOL68fkIvZkRfQAZBX1746169975.png", "https://image.prepladder.com/content/tDRrWfcjvOXehAakDmwI1746169975.png", "https://image.prepladder.com/content/88Px5MFP29DEfYM0UOFz1746169975.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:514px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Anpol42\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bassini_Operation._The_first_suture.jpg\" data-tags=\"\" height=\"585\" src=\"https://image.prepladder.com/content/Fxto3T31GOkxsTgEagXS1746169975.png\" width=\"392\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shouldice Repair:</strong> involves a four-layer repair (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Kumar hari rajah M. Somanathan\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/IsDW33cb5VsEpbIY1L8W1746169975.png\" width=\"391\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented with complaints of hematuria and recurrent urinary tract infection. You notice the following finding in his CT. What is the likely condition indicated by the arrow in the image?", "options": [{"label": "A", "text": "Polycystic kidney disease", "correct": false}, {"label": "B", "text": "Horseshoe kidney", "correct": true}, {"label": "C", "text": "Hydronephrosis", "correct": false}, {"label": "D", "text": "Pancake kidney", "correct": false}], "correct_answer": "B. Horseshoe kidney", "question_images": ["https://image.prepladder.com/notes/qIt24BcRGkBB15kAXHUr1747395962.png"], "explanation_images": ["https://image.prepladder.com/content/qVyxE5oRWl7pw7BonufD1746171893.png", "https://image.prepladder.com/content/6au0oupvcYGh0f2HrIDD1746171893.png", "https://image.prepladder.com/content/TcN4zvpbpUgCdPqrWWJJ1746171893.png", "https://image.prepladder.com/content/wworwKsv8VjCL0UfhOU71746171893.png", "https://image.prepladder.com/content/Vzs1AN436ifUQnC1tj5j1746171893.png", "https://image.prepladder.com/content/xxn0s8TtwuSFMeUE61mn1746171893.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Horseshoe Kidney</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> condition in which the two kidneys are fused at the lower ends, forming a U-shaped structure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>During <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development the kidneys <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> at their lower poles, forming a U-shaped structure.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> results in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> preventing the ascent of the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> to its normal position in the abdomen, leading to an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> location lower in the abdomen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mostly<strong> </strong>asymptomatic.</li>\n<li>Pain: due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs)</li>\n<li>Hydronephrosis</li>\n<li>Hematuria</li>\n<li><strong>Rovsing's syndrome:</strong> Hyperextension of the spine- nausea, vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT Angiography (CT Angio):</strong> This is the investigation of choice for diagnosing a horseshoe kidney, as it allows for detailed <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> anatomy, the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> supply, and associated complications.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:HorseshoeKid2Mark.png\" data-tags=\"\" height=\"549\" src=\"https://image.prepladder.com/content/qVyxE5oRWl7pw7BonufD1746171893.png\" width=\"684\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>CT <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">Abdomen</span> showing Horseshoe kidney</strong></p>\n<ul>\n<li><strong>Contrast-Enhanced CT (CECT): </strong>Used when CT Angio is not available</li>\n<li><strong>Intravenous Pyelogram (IVP) - </strong>characteristic findings include<strong>:</strong>\n<ul>\n<li>Medial Orientation of Calyces: Referred to as the \"<strong>Hand Joining Sign</strong>.\"</li>\n<li>High Insertion of Ureters with Anterior Transposition: This creates a <strong>\"Flower Vase\" appearance of the ureters.</strong></li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Natsis, Konstantinos &amp; Piagkou, Maria &amp; Skotsimara, Antonia &amp; Protogerou, Vassilis &amp; Tsitouridis, Ioannis &amp; Skandalakis, Panagiotis. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/ntravenous-pyelogram-IVP-in-a-male-patient-demonstrating-a-horseshoe-kidney_fig2_277016641\" data-tags=\"\" height=\"495\" src=\"https://image.prepladder.com/content/6au0oupvcYGh0f2HrIDD1746171893.png\" width=\"360\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Aditya Shetty\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/horseshoe-kidney-intravenous-urogram\" data-tags=\"\" height=\"491\" src=\"https://image.prepladder.com/content/TcN4zvpbpUgCdPqrWWJJ1746171893.png\" width=\"385\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Asymptomatic Patients:</strong> Typically do not require treatment, but should be monitored periodically.</li>\n<li><strong>Symptomatic Patients:</strong>\n<ul>\n<li><strong>UPJ Obstruction:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention such as pyeloplasty</li>\n<li><strong>Kidney Stones:</strong> Management may include conservative measures like increased fluid intake, medical therapy, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal</li>\n<li><strong>UTIs:</strong> Treated with antibiotics, and <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> measures may be considered if infections are recurrent.</li>\n<li><strong>Isthmus Management:</strong> The <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> should not be divided surgically as it contains functional <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tissue.</li>\n<li><strong>Pregnancy Considerations:</strong> A <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> can lead to <span class=\"customMeta\" data-dictid=\"e700acb813169277718658466e6e33\">dystocia</span> (difficult labor) due to the kidney's <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> position.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the correct sequence for the correction of hypospadias? Urethroplasty Penile de-gloving Orthoplasty Glanuloplasty", "options": [{"label": "A", "text": "1,3,2,4", "correct": false}, {"label": "B", "text": "2,3,1,4", "correct": true}, {"label": "C", "text": "3,1,4,2", "correct": false}, {"label": "D", "text": "1,3,4,2", "correct": false}], "correct_answer": "B. 2,3,1,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/FaaGPMHMcYuCcBdiDKZW1745337175.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male patient presents with a pelvic fracture following blunt abdominal trauma. No blood is seen at the meatus. Catheterisation does not produce significant urine output. The radiological image is given below. What is the next step in management?", "options": [{"label": "A", "text": "Suprapubic cystostomy", "correct": false}, {"label": "B", "text": "Per Urethral catheterisation", "correct": false}, {"label": "C", "text": "Laparotomy", "correct": true}, {"label": "D", "text": "Pelvic packing along with B/L percutaneous nephrostomy", "correct": false}], "correct_answer": "C. Laparotomy", "question_images": ["https://image.prepladder.com/notes/PJKtCs4Wikp4xvSoMZ3X1745300333.png"], "explanation_images": ["https://image.prepladder.com/notes/LNPdsp684Zi9rY7NehsA1745300408.png", "https://image.prepladder.com/notes/4D8C6tkZ9py1iXKDvg5b1745300540.png", "https://image.prepladder.com/notes/PJKtCs4Wikp4xvSoMZ3X1745300333.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraperitoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Rupture</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves a tear or injury to the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> over the bladder, and <strong>urine leaks into the peritoneal <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> in males.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often occurs in a fully distended bladder, usually due to trauma or injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden, severe pain in the <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> region.</li>\n<li>Signs of shock and syncope.</li>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain with later features of peritonitis.</li>\n<li>Abdominal distension.</li>\n<li>Haematuria</li>\n<li>Absence of desire to urinate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Plain X-ray: </strong>It may show a ground glass appearance.</li>\n<li><strong>Peritoneal Tap:</strong> Used to collect <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> from the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity.</li>\n<li><strong>Cystography: </strong>Iodine <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> is <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> via a <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> to visualise <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> and the <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> entry into the peritoneal cavity. The contrast outlines the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n<li><strong>Ultrasound: </strong>To assess other <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> injuries.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA630\" data-author=\"Vaccaro, Jonathan P. and Jeffrey M. Brody\" data-hash=\"10858\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/CT-cystography-in-the-evaluation-of-major-bladder-Vaccaro-Brody/5170367349da5d43e553d56097d8e85b2b49488b/figure/1\" data-tags=\"April2025\" height=\"349\" src=\"https://image.prepladder.com/notes/LNPdsp684Zi9rY7NehsA1745300408.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Emergency Laparotomy</strong> is required. <strong>(Option C)</strong><strong>.</strong></li>\n<li>Bladder tear is sutured with <span class=\"customMeta\" data-dictid=\"adfa43ce3516927771967791e83ed7\">polylactic acid</span> (vicryl) in two layers.</li>\n<li>Peritoneal wash to clean out the peritoneal cavity.</li>\n<li>Separate <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for <span class=\"customMeta\" data-dictid=\"7458e96e641692777196aaacc2649e\">prevesical</span> space and peritoneal cavity.</li>\n<li>Administration of specific antibiotics to prevent sepsis.</li>\n<li><strong>Catheterisation:</strong>\n<ul>\n<li>Malecot’s <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> is placed suprapubically.</li>\n<li><strong>Foley's <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> passed urethrally.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cystitis /and pyelonephritis.</li>\n<li>Peritonitis.</li>\n<li>Pelvic abscess.</li>\n<li>Fistula formation (vesicovaginal or rectovesical).</li>\n<li>Paralytic ileus.</li>\n<li>Hemorrhage.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extra Peritoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intra Peritoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures and rapid deceleration.</li>\n<li>Leakage into thighs, perineum, penis, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall.</li>\n<li>Commonly associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA629\" data-author=\"Haroon, Samir &amp; Rahimi, Hamza &amp; Merritt, Alexander &amp; Baghdanian, Arthur &amp; Baghdanian, Armonde &amp; LeBedis, Christina.\" data-hash=\"10859\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/a-b-Molar-tooth-sign-39-year-old-man-after-fall-from-a-roof-Axial-a-and-sagittal_fig9_335680851\" data-tags=\"April2025\" height=\"471\" src=\"https://image.prepladder.com/notes/4D8C6tkZ9py1iXKDvg5b1745300540.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Pelvic molar tooth sign:</strong> Contrast media leaking from the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and accumulating in the <span class=\"customMeta\" data-dictid=\"707b8e89cd1692777196474be04ff0\">preperitoneal</span> space, creating a molar tooth-shaped appearance on CT <span class=\"customMeta\" data-dictid=\"f28b2fb03516927771853498063d8e\">cystography</span> after <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs at the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> dome, above the peritoneal reflection.</li>\n<li>Caused by a direct blow to a distended bladder.</li>\n<li>Urine leakage into the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> causes <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> derangements.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"SU721\" data-author=\"Rafael Lourenço do Carmo\" data-hash=\"10857\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/traumatic-intraperitoneal-bladder-rupture\" data-tags=\"April2025\" height=\"171\" src=\"https://image.prepladder.com/notes/PJKtCs4Wikp4xvSoMZ3X1745300333.png\" width=\"258\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a young girl who presents with continuous dribbling of urine despite voiding normally, as reported by her parents, who mention her never being completely dry since birth?", "options": [{"label": "A", "text": "Ectopic ureter", "correct": true}, {"label": "B", "text": "Ureterocele", "correct": false}, {"label": "C", "text": "Congenital megaureter", "correct": false}, {"label": "D", "text": "Vesicoureteric reflux", "correct": false}], "correct_answer": "A. Ectopic ureter", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\"&gt;Ectopic&lt;/span&gt; u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 1-month-old child is brought to the OPD for consultation regarding an empty scrotal sac. On examination B/L inguinal masses are palpable. What is the next step of management for this child?", "options": [{"label": "A", "text": "Perform karyotyping", "correct": false}, {"label": "B", "text": "Surgical exploration within the next 2 weeks", "correct": false}, {"label": "C", "text": "Perform orchidopexy now", "correct": false}, {"label": "D", "text": "Wait and watch for spontaneous descent within the next 6 months.", "correct": true}], "correct_answer": "D. Wait and watch for spontaneous descent within the next 6 months.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) Wait and watch for &lt;span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\"&gt;spontaneous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\"&gt;descent&lt;/span&gt; within the next 6 months</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cryptorchidism is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inguinal/Palpable undescended testis: 80%</li>\n<li>Abdominal/Non-Palpable undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes and Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Developmental and Genetic Factors:</strong> Conditions like <span class=\"customMeta\" data-dictid=\"8e151ee847169277719083d35bdd10\">Klinefelter syndrome</span> and <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> imbalances can impair testicular descent.</li>\n<li><strong>Prematurity and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">Maternal</span> Factors:</strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> birth and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> issues like diabetes or medication exposure can lead to undescended testes.</li>\n<li><strong>Mechanical and Physical Factors: </strong>Obstructions in the inguinal canal, scrotum, or related conditions such as inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> can prevent normal testicular descent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(SATHI Mnemonic):</strong></p>\n<ul>\n<li><strong>S: <span class=\"customMeta\" data-dictid=\"61755425bd1692777199771cd3fa1e\">Sterility</span> -</strong> Elevated <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> temperature can impair <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> production, leading to potential <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> if untreated.</li>\n<li><strong>A: <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> -</strong> Prolonged exposure to heat can cause the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> to shrink or become non-functional.</li>\n<li><strong>T: Trauma, Tumor, <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> </strong>- Increased risk of testicular torsion, which can cause severe pain and potentially result in testicular loss. The most common tumor associated is <span class=\"customMeta\" data-dictid=\"0b7129b26c16927771988bb64b78ef\">seminoma</span> with the highest risk of tumor development in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> testes.</li>\n<li><strong>H: <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> - </strong>Over 90% of cases are associated with a patent <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis, increasing the risk of inguinal hernia.</li>\n<li><strong>I: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> - </strong>The undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions.</li>\n</ul>\n<p><strong>Note: </strong>Leydig cells are unaffected, maintaining secondary sexual characteristics, while Sertoli cells are impaired, affecting spermatogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration.</li>\n<li><strong>Non-Palpable undescended testis:</strong> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> laparoscopy.</li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be utilized to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"5913e35df9169277719717f79fbae7\">Repositioning</span> (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old. <strong>(Option D)</strong></p>\n<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of radiolucent renal stone?", "options": [{"label": "A", "text": "Calcium Oxalate Stones", "correct": false}, {"label": "B", "text": "Uric Acid Stones", "correct": true}, {"label": "C", "text": "Cystine Stones", "correct": false}, {"label": "D", "text": "Xanthine Stones", "correct": false}], "correct_answer": "B. Uric Acid Stones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/82jpF0Y25pWtFruwlzAG1745921697.png", "https://image.prepladder.com/content/EEMPQSpUJ13B2ny8DGnj1745921704.png", "https://image.prepladder.com/content/MnGe9p1yLrm0N5g5zQOr1745921685.png", "https://image.prepladder.com/content/oMBSDum3pOk4mlk6PHR81745921657.png", "https://image.prepladder.com/content/HaJDqRQF9IK7wDoR9TJj1745921648.png", "https://image.prepladder.com/content/sdr862kx0cDOkDznxDO91745921634.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stone Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Oxalate</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>The most common type of stone (60–85% of all stones)</strong>;<strong> Radiopaque</strong></li>\n<li>Associated with hypercalciuria, hypercalcaemia, hyperoxaluria, hyperuricosuria, and hypocitraturia</li>\n<li><strong>Types:</strong> monohydrate (dumbbell-shaped) , <span class=\"customMeta\" data-dictid=\"168c514d4016927771861c453b7a5a\">dihydrate</span> (envelope shaped)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Doruk Salancı\" data-hash=\"\" data-license=\"CC-by-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/82jpF0Y25pWtFruwlzAG1745921697.png\" width=\"127\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong></strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Doruk Salancı\" data-hash=\"\" data-license=\"CC-by-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"254\" src=\"https://image.prepladder.com/content/EEMPQSpUJ13B2ny8DGnj1745921704.png\" width=\"90\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong></strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Phosphate</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pure <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stones are rare</li>\n<li>Types include <span class=\"customMeta\" data-dictid=\"4cd2f5e61a1692777181e000c76341\">apatite</span> and <span class=\"customMeta\" data-dictid=\"142bd44f0b1692777183ea2f5f9fb8\">brushite</span> stones</li>\n<li>Apatite stones are seen with infection; <span class=\"customMeta\" data-dictid=\"142bd44f0b1692777183ea2f5f9fb8\">brushite</span> stones are associated with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mikael Häggström, Klinkhardt, Julius\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://en.m.wikipedia.org/wiki/File:Calcium_phosphate_crystal.jpg\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/MnGe9p1yLrm0N5g5zQOr1745921685.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Struvite</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aka staghorn <span class=\"customMeta\" data-dictid=\"eae898f16d1692777183cc3469a664\">calculi</span> / Triple <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stone (Ca, Mg, NH4+, Phosphate)</li>\n<li><strong>Radiopaque</strong></li>\n<li><strong>Infection stones </strong>that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> due to <strong>urease-producing bacteria</strong> (e.g., <em>Proteus, Klebsiella, Serratia, Enterobacter</em>)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Joel Mills\" data-hash=\"\" data-license=\" CC BY-SA 3.0,\" data-source=\"https://commons.wikimedia.org/w/index.php?curid=1607945\" data-tags=\"\" height=\"416\" src=\"https://image.prepladder.com/content/oMBSDum3pOk4mlk6PHR81745921657.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong></strong> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystine</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radiopaque</strong>, Constitute approximately 1% of stones</li>\n<li>Result from <strong>cystinuria</strong>, an autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> inherited disease that causes decreased <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of cystine.</li>\n<li>Very hard stones due to <span class=\"customMeta\" data-dictid=\"dee47c70a41692777186cf17523799\">disulfide</span> bonds</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Lance Wheeler\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Cystinuria#/media/File:Cystine_Crystals_in_Canine_Urine_Sediment.jpg\" data-tags=\"\" height=\"273\" src=\"https://image.prepladder.com/content/HaJDqRQF9IK7wDoR9TJj1745921648.png\" width=\"259\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uric Acid</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radiolucent </strong></li>\n<li>Promoted by hyperuricosuria, which can be caused by conditions like<strong> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"8dd789d7d1169277719303d4744837\">myeloproliferative</span> disorders</strong></li>\n<li>Precipitates in <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and remains <span class=\"customMeta\" data-dictid=\"845fedd06d16927771989597afa034\">soluble</span> in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> urine.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Iqbal Osman - Queremel Milani DA, Jialal I\" data-hash=\"\" data-license=\"CC By 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Uric_acid_crystals_in_urine_sediment.jpg\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/sdr862kx0cDOkDznxDO91745921634.png\" width=\"347\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is the Whitaker test recommended?", "options": [{"label": "A", "text": "Hydronephrosis", "correct": true}, {"label": "B", "text": "Posterior urethral valve", "correct": false}, {"label": "C", "text": "Urethral atresia", "correct": false}, {"label": "D", "text": "Urethral stricture", "correct": false}], "correct_answer": "A. Hydronephrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"441df40d111692777189b0e31acb06\"&gt;Hydronephrosis&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"8e0b8aa160169277720171f407dac5\">urodynamic</span> test that measures the pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to assess upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equivocal cases of upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction, PUJ obstruction, post-pyeloplasty evaluation, distinguishing true <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> from hydronephrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> <span class=\"customMeta\" data-dictid=\"d1daf6e6e71692777193b4da27724f\">nephrostomy</span> placed in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis.</p>\n<p>2. <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> inserted for pressure measurement.</p>\n<p>3. Fluid <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> into <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> at 10 ml/min.</p>\n<p>4. Pressure difference between <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> &amp; <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> recorded.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;15 cm H₂O → No obstruction.</p>\n<p>15–22 cm H₂O → Indeterminate (needs further evaluation).</p>\n<p>&gt;22 cm H₂O → Significant <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> true <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> vs. non-obstructive dilation.</p>\n<p>Useful in post-surgical cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive (rarely used due to modern imaging).</p>\n<p>Replaced by <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> scan (DTPA/EC scan) &amp; MR Urography.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old man was referred to the surgery OPD from the infertility clinic. On palpation, a bag of worms sensation was felt with dilated veins. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Varicocele", "correct": true}, {"label": "C", "text": "Testicular torsion", "correct": false}, {"label": "D", "text": "Epididymo Orchitis", "correct": false}], "correct_answer": "B. Varicocele", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8wzQAVFRIF42xU0bQ98g1745929006.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Varicocele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Occurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in tall, thin young men</li>\n<li>More frequent on the left side but can be bilateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic</li>\n<li>Absence or <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of the left testicular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</li>\n<li>Perpendicular entry of the left testicular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> into the left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</li>\n<li>Left-sided <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> causing <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of the left testicular vein</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased temperature in the scrotum, depressing <span class=\"customMeta\" data-dictid=\"a3b0e644a6169277719912525dffae\">spermatogenesis</span> and causing infertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling at the root of the scrotum</li>\n<li>Dragging pain in the <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> and scrotum</li>\n<li>\"Bag of worms\" feeling</li>\n<li>Impulse on coughing</li>\n<li>Swelling reduces on lying down (except in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> of the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> and groin</li>\n<li>Ultrasound of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to check for <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumours</li>\n<li>Semen analysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palomo's Operation: <span class=\"customMeta\" data-dictid=\"f8c909c45c16927771998f20372bcb\">Suprainguinal</span> <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> of the testicular vein</li>\n<li>Ligation of veins</li>\n<li>Excision of veins</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the best treatment option for a patient who has been diagnosed with renal cell carcinoma and has a tumour measuring 10 cm in size, located at the lower part of the kidney, and has negative regional lymph nodes?", "options": [{"label": "A", "text": "Radical nephrectomy", "correct": true}, {"label": "B", "text": "Partial nephrectomy", "correct": false}, {"label": "C", "text": "Radiotherapy", "correct": false}, {"label": "D", "text": "Chemotherapy", "correct": false}], "correct_answer": "A. Radical nephrectomy", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment of RCC: RCCs are radio and chemo-resistant.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Nephrectomy: </strong>Involves removing only the tumour while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</p>\n<p><strong>Indications: </strong>Larger tumours or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and <span class=\"customMeta\" data-dictid=\"ef32d1f4571692777185565852b47f\">Cryoablation</span> </strong>involve destroying the tumour using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumours (T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a patient who has a scrotal mass on the left side that is hard in texture, has uneven edges, does not decrease in size when lying down or manipulated, does not have a cough impulse, but shows enlargement in the para-aortic lymph nodes?", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Direct inguinal hernia", "correct": false}, {"label": "C", "text": "Indirect inguinal hernia", "correct": false}, {"label": "D", "text": "Metastasising testicular tumor", "correct": true}], "correct_answer": "D. Metastasising testicular tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) Metastasizing testicular tu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-month-old male baby presented with an empty scrotum. Ultrasonography revealed that the right testis was found in the right inguinal canal, while the left testis was found in the perineum. Comment on the diagnosis of this baby.", "options": [{"label": "A", "text": "Bilateral undescended testis", "correct": false}, {"label": "B", "text": "Bilateral ectopic testis", "correct": false}, {"label": "C", "text": "Right-side undescended testis and left-sided ectopic testis", "correct": true}, {"label": "D", "text": "Right side ectopic testis and left side undescended testis", "correct": false}], "correct_answer": "C. Right-side undescended testis and left-sided ectopic testis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DhufrYvgU4pd5EZvuLpW1746017229.png"], "explanation": "<p>Correct Option C) Right-side undescended &lt;span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\"&gt;testis&lt;/span&gt; and left-sided &lt;span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\"&gt;ectopic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 14-year-old boy who is experiencing sudden scrotal pain, where physical examination reveals a swollen and red scrotum with the right testes being retracted, absent cremasteric reflex, and negative Prehn's sign?", "options": [{"label": "A", "text": "Right-sided hydrocele", "correct": false}, {"label": "B", "text": "Strangulated inguinal hernia", "correct": false}, {"label": "C", "text": "Right testicular torsion", "correct": true}, {"label": "D", "text": "Right epididymo orchitis", "correct": false}], "correct_answer": "C. Right testicular torsion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Right testicu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direction of Rotation</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Right Testis: Rotates clockwise</li>\n<li>Left Testis: Rotates counterclockwise</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Predisposing Factors</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inversion of the Testis</li>\n<li>High Investment in <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">Tunica</span> Vaginalis</li>\n<li>Gap Between <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> and Epididymis</li>\n<li>Heavy Straining</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age Group: Common in children and adolescents</li>\n<li>Symptoms: Sudden onset of pain in the scrotum, groin, and lower abdomen; <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> due to pylorospasm</li>\n<li>Signs: Tenderness, redness, and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the scrotal skin</li>\n<li>Deming's Sign: Affected <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is positioned high due to twisting and <span class=\"customMeta\" data-dictid=\"e082e05dc416927771853d8fbe8044\">cremaster</span> muscle spasm</li>\n<li>Angell's Sign: Opposite <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> lies horizontally due to the presence of mesorchium</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>WBC Count: Elevated levels</li>\n<li>Doppler Study: To assess testicular <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pulsation</li>\n<li>Ultrasound Abdomen</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emergency Exploration: <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">Scrotum</span> exploration and untwisting of the testis. The <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> of the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is checked.</li>\n<li>Fixation: If viable, the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is fixed to the scrotal <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> with 2-3 <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> nonabsorbable sutures (Prolene).</li>\n<li>Timing: If surgery occurs within 12-24 hours, <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> may be retained. Any delay can lead to gangrene, requiring orchidectomy.</li>\n<li>Orchidectomy Consideration: If in doubt, the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> can be retained temporarily, with <span class=\"customMeta\" data-dictid=\"97af60ca4a16927771940d71c8f0fc\">orchidectomy</span> postponed to assess viability.</li>\n<li>Postoperative Care: A repeat <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> study confirms viability. The opposite <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> should also be fixed to prevent torsion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for an elderly male patient who has come to the hospital with lower back pain, a movable mass in the lower back that becomes more prominent when breathing in and a general feeling of weakness? The lab tests show the presence of red blood cells in the urine, with no sign of pus cells.", "options": [{"label": "A", "text": "Polycystic kidney disease", "correct": false}, {"label": "B", "text": "Hydronephrosis", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": true}, {"label": "D", "text": "Chronic pyelonephritis", "correct": false}], "correct_answer": "C. Renal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;Renal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 60-year-old male who is experiencing lower back pain and has sclerotic lesions in the vertebrae?", "options": [{"label": "A", "text": "Carcinoma prostate", "correct": true}, {"label": "B", "text": "Tuberculosis", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": false}, {"label": "D", "text": "Carcinoma colon", "correct": false}], "correct_answer": "A. Carcinoma prostate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prostate cancer spreads <strong>hematogenously to bones</strong>, commonly affecting the <strong>spine, pelvis, ribs, and femur</strong>. <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">Metastases</span> are <strong>osteoblastic (sclerotic)</strong> due to increased <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> activity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower back pain</strong>, <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> symptoms (hesitancy, frequency), and <strong>neurological deficits if <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> occurs</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PSA – Elevated</strong>, <strong>ALP – Elevated</strong> (bone involvement), <strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> – Normal/mildly elevated</strong> (osteoblastic <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> do not cause severe hypercalcemia).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sclerotic (osteoblastic) lesions</strong> in vertebrae, pelvis, and long bones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone Scan (Tc-99m)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shows <strong>increased <span class=\"customMeta\" data-dictid=\"c5a32dfd6e1692777197db92b6aea1\">radiotracer</span> uptake</strong> in metastatic sites (best for early detection).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI Spine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects <strong>spinal cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> infiltration</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Pelvis/Spine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defines <strong>bone <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> and local spread</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Confirmatory Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TRUS-guided <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> biopsy</strong> (Transrectal <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> Biopsy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Androgen <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Therapy (ADT)</strong> (GnRH agonists like Leuprolide), <strong>Bisphosphonates for bone health</strong>, Radiation for <strong>spinal metastases</strong>, and <strong>Surgical <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> if cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> occurs</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of trauma has a ruptured bulbar urethra. What is the location for the accumulation of urine?", "options": [{"label": "A", "text": "Superficial pouch", "correct": true}, {"label": "B", "text": "Deep pouch", "correct": false}, {"label": "C", "text": "Rectouterine pouch", "correct": false}, {"label": "D", "text": "Uterovesical pouch", "correct": false}], "correct_answer": "A. Superficial pouch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/12ysO49oDxKPf0uKSZuX1746078174.png", "https://image.prepladder.com/content/tWQ4dHuHQiDivlKSZcPe1746078174.png", "https://image.prepladder.com/content/JN795bQlLwnZi76dFDHh1746078174.png"], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\"&gt;Superficial&lt;/span&gt; pouch</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/tWQ4dHuHQiDivlKSZcPe1746078174.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/JN795bQlLwnZi76dFDHh1746078174.png\" width=\"381\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pelvic fractures (often due to motor vehicle accidents)</li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising (butterfly-shaped hematoma)</li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood at the meatus</li>\n<li>Inability to void</li>\n<li>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</li>\n<li>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: Gold standard, shows the extent and location of the injury</li>\n<li>Voiding Cystourethrography (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU): Gold standard for initial assessment</li>\n<li>CT Urethrography: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Cystoscopy: Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- Pie in-sky appearance</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a newborn male with an undeveloped scrotum, the testis was observed to be located near the peritoneum. Which of the following factors aids in the descent of the testis into the scrotum?", "options": [{"label": "A", "text": "GnRH Analogues", "correct": true}, {"label": "B", "text": "Testosterone", "correct": false}, {"label": "C", "text": "Cold Compressions", "correct": false}, {"label": "D", "text": "Manually bring the testis down to the bottom of scrotum.", "correct": false}], "correct_answer": "A. GnRH Analogues", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) GnRH Analogu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cryptorchidism is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inguinal/Palpable undescended testis: 80%</li>\n<li>Abdominal/Non-Palpable undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes and Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Developmental and Genetic Factors:</strong> Conditions like <span class=\"customMeta\" data-dictid=\"8e151ee847169277719083d35bdd10\">Klinefelter syndrome</span> and <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> imbalances can impair testicular descent.</li>\n<li><strong>Prematurity and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">Maternal</span> Factors:</strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> birth and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> issues like diabetes or medication exposure can lead to undescended testes.</li>\n<li><strong>Mechanical and Physical Factors: </strong>Obstructions in the inguinal canal, scrotum, or related conditions such as inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> can prevent normal testicular descent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(SATHI Mnemonic):</strong></p>\n<ul>\n<li><strong>S: <span class=\"customMeta\" data-dictid=\"61755425bd1692777199771cd3fa1e\">Sterility</span> -</strong> Elevated <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> temperature can impair <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> production, leading to potential <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> if untreated.</li>\n<li><strong>A: <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> -</strong> Prolonged exposure to heat can cause the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> to shrink or become non-functional.</li>\n<li><strong>T: Trauma, Tumor, <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> </strong>- Increased risk of testicular torsion, which can cause severe pain and potentially result in testicular loss. The most common tumor associated is seminoma, with the highest risk of tumor development in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> testes.</li>\n<li><strong>H: <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> - </strong>Over 90% of cases are associated with a patent <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis, increasing the risk of inguinal hernia.</li>\n<li><strong>I: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> - </strong>The undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions.</li>\n</ul>\n<p><strong>Note: </strong>Leydig cells are unaffected, maintaining secondary sexual characteristics, while Sertoli cells are impaired, affecting spermatogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration.</li>\n<li><strong>Non-Palpable undescended testis:</strong> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> laparoscopy.</li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be utilised to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"5913e35df9169277719717f79fbae7\">Repositioning</span> (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old.</p>\n<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with scrotal enlargement. His LDH levels are notably elevated, while HCG and alpha-fetoprotein levels remain within normal ranges. Upon histopathological examination, the findings are as shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Leydig cell tumor", "correct": false}, {"label": "B", "text": "Embryonal carcinoma", "correct": false}, {"label": "C", "text": "Seminoma", "correct": true}, {"label": "D", "text": "Teratoma", "correct": false}], "correct_answer": "C. Seminoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TPjNQFn0qAVpPNvuOrVd1747911666.png", "https://image.prepladder.com/content/EdeuL4S0J7LN6VVgZBcs1747911657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seminoma, the most common pure testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> aged 25-45</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Germinal <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, firm <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or mass in the testicle, typically unilateral. Accounts for 50% of all testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors. 10% have secondary hydrocele, 5% have gynecomastia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFP: Normal</p>\n<p>hCG: Normal or mildly elevated</p>\n<p>LDH: Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound: Homogeneous, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> mass</p>\n<p>Histology: Sheets of <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> cells with clear cytoplasm, large <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> with prominent <span class=\"customMeta\" data-dictid=\"829d67cd9816927771800b7303f9cc\">acidophilic</span> nucleoli</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alex_brollo\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Testis_seminoma_3.jpg\" data-tags=\"\" height=\"3301\" src=\"https://image.prepladder.com/content/TPjNQFn0qAVpPNvuOrVd1747911666.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"0\" src=\"https://image.prepladder.com/content/EdeuL4S0J7LN6VVgZBcs1747911657.png\" width=\"0\"/></p>\n<p>FNAC: Contraindicated due to the risk of tumour cell seeding and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary: High Inguinal Radical Orchidectomy</p>\n<p>Adjuvant: Radiation therapy or <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> for positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male underwent lumbar sympathectomy, and bilateral L1 ganglions were removed. What will be the most common side effect?", "options": [{"label": "A", "text": "Impotence", "correct": false}, {"label": "B", "text": "Retrograde ejaculation", "correct": true}, {"label": "C", "text": "Bladder dysfunction", "correct": false}, {"label": "D", "text": "Incontinence", "correct": false}], "correct_answer": "B. Retrograde ejaculation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) &lt;span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\"&gt;Retrograde&lt;/span&gt; ejacu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All the following are features of polycystic disease of kidneys except:", "options": [{"label": "A", "text": "Hematuria", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "Renal failure", "correct": false}, {"label": "D", "text": "Erythrocytosis", "correct": true}], "correct_answer": "D. Erythrocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PgjovjIDIRXXI0cP7yj71746081832.png", "https://image.prepladder.com/content/xvqFm2KfO8bpdIS4YvHM1746081832.png", "https://image.prepladder.com/content/0FUr6KcfY80aK2y9QeJ91746081832.png", "https://image.prepladder.com/notes/vrGrdC8Qgre17m3jap8F1747728835.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of cysts into the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> collecting system</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Result of <strong>renin-angiotensin system (RAS) activation</strong> due to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> from <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> compression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Progressive <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> expansion leads to <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> loss, causing <strong>chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythrocytosis (Absent)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CKD leads to <strong>decreased <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> (EPO)</strong>, resulting in <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> rather than polycythemia</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ADPKD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ARPKD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Affected age group</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cysts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Are present in both outer and inner surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present only on the inner surface.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involved gene</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PKD 1 on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16</li>\n<li>PKD 2 on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 4</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PKHD on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 6</p>\n<p>(Statement 2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protein affected</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>polycystin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrocystin (Statement 3)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Histology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Polycystic_kidney_disease_--_2_-_high_mag.jpg\" data-tags=\"\" height=\"214\" src=\"https://image.prepladder.com/content/PgjovjIDIRXXI0cP7yj71746081832.png\" width=\"320\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Patrick Walker, MD.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://aspneph.org/autosomal-recessive-polycystic-kidney-disease-arpkd/\" data-tags=\"\" height=\"208\" src=\"https://image.prepladder.com/content/xvqFm2KfO8bpdIS4YvHM1746081832.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Coronary or <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> heart disease (40%). <strong>(Statement 4)</strong></li>\n<li>Infection (25%).</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"92ff33318a16927771828d959514b8\">berry</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> or <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> <span class=\"customMeta\" data-dictid=\"c7f167b8df1692777190bcd90fe428\">intracerebral</span> haemorrhage (15%).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neonatal period:\n\t\t\t\t<ul>\n<li>Respiratory failure due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypoplasia.</li>\n<li>Renal failure.</li>\n</ul>\n</li>\n<li>Childhood and adolescence:\n\t\t\t\t<ul>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure leading to ESRD.</li>\n<li>Complications of CKD.</li>\n<li>Complications from <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> fibrosis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Images</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC/ Dr. Edwin P. Ewing, Jr.\" data-hash=\"\" data-license=\"Public domain\" data-source=\"https://commons.wikimedia.org/wiki/File:Polycystic_kidneys,_gross_pathology_CDC_PHIL.png\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/content/0FUr6KcfY80aK2y9QeJ91746081832.png\" width=\"319\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ADPKD gross\" data-author=\"NA\" data-hash=\"13066\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" height=\"248\" src=\"https://image.prepladder.com/notes/vrGrdC8Qgre17m3jap8F1747728835.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26 year old male presented with a painless large round firm right testicular swelling, with a dragging sensation. The left testis was normal. AFP was around 3000U. What is the next best step in the management?", "options": [{"label": "A", "text": "FNAC", "correct": false}, {"label": "B", "text": "Scrotal true cut biopsy", "correct": false}, {"label": "C", "text": "High inguinal orchidectomy", "correct": true}, {"label": "D", "text": "Repeat tumor markers", "correct": false}], "correct_answer": "C. High inguinal orchidectomy", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AFP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-hCG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LDH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Seminoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>± Mildly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common <strong>germ cell tumor (GCT)</strong>, <strong>radiosensitive</strong>, good prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Embryonal Carcinoma</strong> (NSGCT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>± Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>± Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aggressive</strong>, commonly mixed with other GCTs, often has <strong>hemorrhage &amp; necrosis</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">Sac</span> Tumor</strong> (Endodermal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Tumor)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common <strong>testicular tumor in children</strong>, <strong>Schiller-Duval bodies</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Choriocarcinoma</strong> (NSGCT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly <strong>malignant</strong>, <strong>hematogenous spread</strong>, causes <strong>gynecomastia</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teratoma</strong> (NSGCT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains <strong>all 3 <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> layers</strong>, <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> teratomas are <strong>chemoresistant</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">Germ</span> Cell Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AFP or β-hCG may be elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>± Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination of <strong>seminoma + NSGCT</strong>, <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> depends on dominant component.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leydig Cell Tumor</strong> (Sex Cord-Stromal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> <strong>testosterone</strong>, causes <strong>precocious <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> or gynecomastia</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sertoli Cell Tumor</strong> (Sex Cord-Stromal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, usually <strong>hormonally silent</strong>, incidental finding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old was brought to the ER after falling off his bicycle. His vitals were stable, but he had a bruise over the perineum, and he had not passed urine yet. Blood was seen at the meatus and the bladder was not palpable. How do you manage him?", "options": [{"label": "A", "text": "Wait and send him home", "correct": false}, {"label": "B", "text": "Immediate insertion of a Foley catheter", "correct": false}, {"label": "C", "text": "Suprapubic aspiration of urine", "correct": false}, {"label": "D", "text": "Wait for bladder to fill and urge to urinate", "correct": true}], "correct_answer": "D. Wait for bladder to fill and urge to urinate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary reason for bladder outlet obstruction in male children?", "options": [{"label": "A", "text": "Posterior urethral valve", "correct": true}, {"label": "B", "text": "Urethral atresia", "correct": false}, {"label": "C", "text": "Anterior urethral valve", "correct": false}, {"label": "D", "text": "Ureterocele", "correct": false}], "correct_answer": "A. Posterior urethral valve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right–sided reniform ballotable mass was found. What investigations will you do? 1. CECT 2. PET-CT 3. 24 hour urinary VMA 4. FNAC", "options": [{"label": "A", "text": "1 and 2", "correct": false}, {"label": "B", "text": "2 and 4", "correct": false}, {"label": "C", "text": "1, 2 and 3", "correct": true}, {"label": "D", "text": "1, 2, 3 and 4", "correct": false}], "correct_answer": "C. 1, 2 and 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:539px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role in Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Justification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CECT (Contrast-Enhanced CT Scan)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-line <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tumors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Determines <strong>tumor size, extent, local invasion, and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> involvement</strong> (e.g., <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> or <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> thrombus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PET-CT (Positron Emission Tomography-CT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staging and <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> detection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps assess <strong>lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement, lung, liver, and bone metastases</strong>. Also differentiates <strong>Wilms tumor vs. neuroblastoma</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"704b81e54a1692777202822180da1e\">VMA</span> (Vanillylmandelic Acid)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiates <span class=\"customMeta\" data-dictid=\"8b8f271ea516927772024ef17cdb69\">Wilms tumor</span> from Neuroblastoma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuroblastoma (adrenal origin) → elevated <span class=\"customMeta\" data-dictid=\"704b81e54a1692777202822180da1e\">VMA</span> levels</strong>; <span class=\"customMeta\" data-dictid=\"8b8f271ea516927772024ef17cdb69\">Wilms tumor</span> <strong>does not</strong> produce catecholamines.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>FNAC (Fine Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> Cytology)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not recommended</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindicated in Wilms tumor</strong> due to <strong>risk of tumor spillage</strong>, which can lead to peritoneal dissemination. <strong>Core <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> may be done in unclear cases.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient came to the outpatient department with complaints of hematuria. A 2x2 cm bladder mass is seen which is low grade transitional cell carcinoma. Which among the following is the ideal management?", "options": [{"label": "A", "text": "Transurethral resection of the tumor", "correct": true}, {"label": "B", "text": "Resection with ileal conduit", "correct": false}, {"label": "C", "text": "Partial cystectomy with bladder reconstruction", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy", "correct": false}], "correct_answer": "A. Transurethral resection of the tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"041fb2c22116927772007921f33a1e\"&gt;Transurethral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\"&gt;resection&lt;/span&gt; of the tumour</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Tumor Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Tis (Carcinoma in situ)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT (Transurethral <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Tumor)</strong></p>\n<ul>\n<li>May be used for initial diagnosis and tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> if not already performed</li>\n</ul>\n<p><strong>Intravesical BCG</strong></p>\n<ul>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Weekly for 3 weeks at months 3, 6, 12, 18, 24, 30, and 36</li>\n</ul>\n<p><strong>Continue <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> Maintenance Therapy</strong></p>\n<ul>\n<li>Up to 3 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ta (Non-muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong></p>\n<ul>\n<li>Complete <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of tumor</li>\n</ul>\n<p><strong>Low-risk:</strong></p>\n<ul>\n<li>Single <span class=\"customMeta\" data-dictid=\"bcf4f8a2be16927771907cf5f046c5\">Instillation</span> (SI) of <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">Intravesical</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine, mitomycin)</li>\n<li>SI within 24 hours of TURBT</li>\n<li>Alternative: Continuous <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> irrigation</li>\n</ul>\n<p><strong>Intermediate-risk:</strong></p>\n<ul>\n<li>Intravesical <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine)</li>\n<li>Induction: 6 weekly courses</li>\n<li>Maintenance: Up to 1 year</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T1 (Muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong>- For initial diagnosis and tumor debulking</p>\n<p><strong>High-risk:</strong></p>\n<ul>\n<li>Intravesical BCG</li>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Up to 3 years</li>\n</ul>\n<p><strong>Consider Cystectomy</strong></p>\n<ul>\n<li>If <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> is not tolerated or ineffective- Alternative: Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T2 (Muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong>- May be used for tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and staging</p>\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Consider Cystectomy</li>\n<li>Alternatively, Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Depending on response and tumor characteristics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T3 (Advanced muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy with possible <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> chemotherapy</li>\n</ul>\n<p><strong>TURBT </strong>- Often not performed if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> is planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Based on <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> and staging</li>\n<li>Neoadjuvant therapy may continue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T4 (Locally advanced)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy</li>\n<li>Neoadjuvant Chemotherapy, if not yet administered</li>\n</ul>\n<p><strong>TURBT</strong>- Typically avoided if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> and <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> therapy are planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Additional <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or radiation based on <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> disease and staging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true regarding the condition mentioned below?", "options": [{"label": "A", "text": "Patient must be started on anti-gas gangrene serum therapy", "correct": false}, {"label": "B", "text": "It is a mixed flora aerobic and anaerobic infection", "correct": true}, {"label": "C", "text": "Bilateral orchiectomy is generally performed", "correct": false}, {"label": "D", "text": "Compulsory urinary diversion is performed", "correct": false}], "correct_answer": "B. It is a mixed flora aerobic and anaerobic infection", "question_images": ["https://image.prepladder.com/notes/jDvw1guqwK3KI7ANEt8K1746449301.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Necrotizing infection of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is usually caused by mixed bacterial fora (Escherichia coli, Bacteroides spp., Streptococcus pyogenes, Staphylococcus aureus). <strong>(Option B) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms: Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li>Prodromal Phase: Fever and lethargy.</li>\n<li>Early Pain Phase: Intense pain, possible oedema, pruritus.</li>\n<li>Progressive Phase: Increased pain, and erythema.</li>\n<li>Crepitation Phase: Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li>Gangrene Phase: <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from localised <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial Treatment:\n\t\t\t\t<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li>Additional Measures:\n\t\t\t\t<ul>\n<li>Urinary and fecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with abdominal pain and sterile pyuria, what is the finding shown in the image given?", "options": [{"label": "A", "text": "Putty kidney", "correct": true}, {"label": "B", "text": "Nephrocalcinosis", "correct": false}, {"label": "C", "text": "Staghorn calculus", "correct": false}, {"label": "D", "text": "Psoas calcification", "correct": false}], "correct_answer": "A. Putty kidney", "question_images": ["https://image.prepladder.com/content/kiEI6VDhX5EUgjZcVeUx1745472776.png"], "explanation_images": ["https://image.prepladder.com/content/5gSx6lJ8GQv9zLntFjQz1745472816.png", "https://image.prepladder.com/content/1SM85cDZfbCpKhjICjcX1745472816.png", "https://image.prepladder.com/notes/66FAyySbO1tzSucoNAj41746449857.png", "https://image.prepladder.com/notes/rPrblzaXxEPpLMT2rblj1746449877.png", "https://image.prepladder.com/notes/O6ReSTQJZH3knt0AvHKT1746449899.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man with prostate carcinoma presents to you with a PSA of 9 ng/mL with a small tumour focus. His Gleason score is 6. What will be your most likely management?", "options": [{"label": "A", "text": "Radical prostatectomy", "correct": false}, {"label": "B", "text": "External beam radiation", "correct": false}, {"label": "C", "text": "Brachytherapy", "correct": false}, {"label": "D", "text": "Active surveillance", "correct": true}], "correct_answer": "D. Active surveillance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gleason</strong></p>\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade</strong></p>\n<p><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cancer</strong></p>\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells resemble healthy tissue; low likelihood of growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 + 4 or 4 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells show more variation and moderate risk of growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 + 4, 3 + 5, or 5 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells look very different; higher likelihood of rapid growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 or 10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 + 5, 5 + 4, or 5 + 5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very high-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells are highly aggressive and very likely to grow and spread quickly.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Active Surveillance (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For low-risk cases, regular monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical <span class=\"customMeta\" data-dictid=\"4f419067a61692777196c1039e5eb3\">Prostatectomy</span> </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiation Therapy</strong></p>\n<p><strong>(Option B, C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-energy rays; external or brachytherapy</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormone Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces/block testosterone; for advanced/metastatic cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic drug treatment; for advanced/metastatic cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives after being involved in a motorcycle road traffic accident. The patient does not report any pain or injury. Upon examination, there is evidence of blood at the urethral meatus. What would be your subsequent course of action in terms of managing this patient?", "options": [{"label": "A", "text": "Foley’s catheterization", "correct": false}, {"label": "B", "text": "Wait and watch", "correct": true}, {"label": "C", "text": "Nephrogram", "correct": false}, {"label": "D", "text": "Suprapubic cystostomy", "correct": false}], "correct_answer": "B. Wait and watch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4GIDQnvDJKGS8ie2bkPY1745476842.png", "https://image.prepladder.com/content/p8HSH1bSCM1v9DfNRWdz1745476842.png", "https://image.prepladder.com/content/UXArrtTgoohKqaPFYKi61745476842.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p> </p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/p8HSH1bSCM1v9DfNRWdz1745476842.png\" width=\"200\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/UXArrtTgoohKqaPFYKi61745476842.png\" width=\"200\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterisation, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic fractures (often due to motor vehicle accidents)</strong></li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria</li>\n<li>Penile/perineal bruising (butterfly-shaped hematoma)</li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood at the meatus</li>\n<li>Inability to void</li>\n<li>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</li>\n<li>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: Gold standard, shows the extent and location of the injury</li>\n<li><strong>Voiding <span class=\"customMeta\" data-dictid=\"c65af338d916927771853b83a9c9c5\">Cystourethrography</span> (VCUG):</strong> Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li><strong>Ultrasound:</strong> Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU):</strong> Gold standard for initial assessment</li>\n<li><strong>CT Urethrography: </strong>Useful in evaluating complex injuries</li>\n<li><strong>Pelvic CT Scan: </strong>Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li><strong>Cystoscopy: </strong>Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- Pie in-sky appearance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Minor Injuries:</strong> Managed conservatively with catheterisation or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> if severe bruising</li>\n<li><strong>Severe Injuries:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention like primary repair, urethroplasty, or end-to-end anastomosis</li>\n<li><strong>Antibiotics: </strong>To prevent infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Management:</strong> <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">Suprapubic</span> <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> diversion</li>\n<li><strong>Delayed <span class=\"customMeta\" data-dictid=\"efb09641831692777201e1dcdc5f83\">Urethroplasty</span> (Definitive management):</strong> 3-6 months post-injury after <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> have subsided</li>\n<li><strong>Primary Realignment:</strong> Occasionally attempted if conditions permit</li>\n<li><strong>Endoscopic Realignment:</strong> For selected cases, though often reserved for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urethral <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> (risk of recurrence)</li>\n<li>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (especially if injury near the penile base)</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (less common)</li>\n<li>Infection (urethritis or <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation)</li>\n<li>Bladder neck contracture</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a girl who has experienced continuous urinary dribbling and persistent bladder fullness since birth?", "options": [{"label": "A", "text": "Stress incontinence", "correct": false}, {"label": "B", "text": "Ureterocele", "correct": false}, {"label": "C", "text": "Ectopic ureter", "correct": true}, {"label": "D", "text": "Vesicovaginal fistula", "correct": false}], "correct_answer": "C. Ectopic ureter", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ectopic ureter</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It results from <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> embryological development, often associated with<strong> ureteral duplication.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ectopic ureters drain to sites other than the bladder, which is commonly associated with <span class=\"customMeta\" data-dictid=\"a474651a3816927771869b71041ec1\">duplication</span> of the ureter.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>In females, <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> ureters open below the urethral <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> or into the vagina, leading to <strong>incontinence</strong>.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>In males, <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> ureters usually open above the external urethral sphincter, maintaining continence.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> ureters (10% of cases).</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Unilateral <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> ureters.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Females: Continuous <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> despite normal voiding.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Males: Typically <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or continent due to <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> opening above the sphincter.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Computed Tomo-Urography (CTU).</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"76d8f9a76716927772019c9b8a5fb8\">Urography</span> (MRU).</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primarily imaging-based <span class=\"customMeta\" data-dictid=\"15329af01a1692777186974b692f03\">diagnostics</span> (CTU or MRU).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Persistent <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> in females.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Potential <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Vesicoureteral Reflux</p>\n</li>\n<li>\n<p>Urethral Stricture: Difficulty in <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and weak stream, not continuous incontinence.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Neurogenic Bladder</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Surgical correction: </strong>Reposition it into the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to restore normal continence.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the investigation and the lesion depicted in the image given below:", "options": [{"label": "A", "text": "Retrograde cystourethrogram with membranous urethra stricture", "correct": false}, {"label": "B", "text": "Retrograde cystourethrogram with penile urethral stricture", "correct": true}, {"label": "C", "text": "Micturating cystourethrography with bulbar stricture", "correct": false}, {"label": "D", "text": "Micturating cystourethrography with prostatic urethra stricture", "correct": false}], "correct_answer": "B. Retrograde cystourethrogram with penile urethral stricture", "question_images": ["https://image.prepladder.com/notes/GviO7vOb60TnhQvULcWK1746431354.png"], "explanation_images": ["https://image.prepladder.com/notes/kWnUqdaWhhttIUEFqzsI1746431490.png", "https://image.prepladder.com/notes/z4MOC6LYUzvUXX7l688z1746431579.png", "https://image.prepladder.com/notes/TpUEYCyOtLmTHpCNvTOG1746431821.png"], "explanation": "<p>Correct Answer B - Retrograde &lt;span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\"&gt;cystourethrogram&lt;/span&gt; with penile urethral stricture</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Urethral Stricture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal narrowing of the <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> causes partial or complete <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> flow, leading to discomfort and severe complications if untreated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trauma (Most common): </strong>Pelvic fractures, falls, accidents, or <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> trauma from prolonged catheterization.</p>\n<p><strong>Infections: </strong>STIs like gonorrhoea and <span class=\"customMeta\" data-dictid=\"21e09b6e771692777184f66df5bf7a\">chlamydia</span> cause urethritis.</p>\n<p><strong>Medical Procedures</strong>: Urethral surgeries or radiation for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cancers.</p>\n<p><strong>Inflammatory Conditions:</strong> Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> from conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> sclerosus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Urethral Stricture:</strong> <strong>Micturating <span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\">Cystourethrogram</span> (MCU)</strong> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> during voiding. <strong>(Option C &amp; D ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PSU099\" data-author=\"Pal, Partha &amp; Ray, Sayantan &amp; Talukdar, Arunansu &amp; Sonthalia, Nikhil &amp; Chakraborty, Sumit.\" data-hash=\"11765\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-Retrograde-urethrogram-demonstrating-a-narrowing-in-the-proximal-bulbar-urethra-B_fig2_262531126\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/kWnUqdaWhhttIUEFqzsI1746431490.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Anterior Urethral Stricture:</strong> <strong>Retrograde Urethrogram (RGU).</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PSU100\" data-author=\"NA\" data-hash=\"11769\" data-license=\"NA\" data-source=\"https://www.keshavamhospital.com/stricture-urethra.php\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/z4MOC6LYUzvUXX7l688z1746431579.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Emergency Evaluation: </strong>Both RGU and MCU may be used in trauma cases or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urethral Dilation:</strong> Temporary relief with dilators, often leading to recurrence.</p>\n<p><strong>Optical Internal Urethrotomy (OIU):</strong> Endoscopic <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> at the 12 o'clock position; effective for short <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> strictures (&lt;2 cm).</p>\n<p><strong>Urethroplasty:</strong> Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and reconstruction; the gold standard for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> or complex strictures</p>\n<ul>\n<li><strong>Strictures up to 2 cm:</strong> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> with end-to-end anastomosis.</li>\n<li><strong>Strictures &gt;2 cm:</strong> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> and <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> with <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> mucosa, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> mucosa, or penile skin.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient was brought to the emergency department following a fall into a manhole, resulting in injury to his perineum. He experiences a strong urge to urinate but is unable to do so. During examination, blood is observed at the opening of the urethra, and there is swelling of the penis and scrotum. Which specific area is affected by the injury?", "options": [{"label": "A", "text": "Membranous urethra rupture", "correct": false}, {"label": "B", "text": "Bulbar urethra injury", "correct": true}, {"label": "C", "text": "Prostatic urethra injury", "correct": false}, {"label": "D", "text": "Urinary bladder rupture", "correct": false}], "correct_answer": "B. Bulbar urethra injury", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aCycOyyO2IRERdLNC88n1745234632.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\"&gt;Bulbar&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\"&gt;urethra&lt;/span&gt; injury</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"704\" src=\"https://image.prepladder.com/content/aCycOyyO2IRERdLNC88n1745234632.png\" width=\"705\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising<strong> (butterfly-shaped hematoma)</strong></li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: <strong>Gold standard</strong>, shows the extent and location of injury</li>\n<li>Voiding <span class=\"customMeta\" data-dictid=\"c65af338d916927771853b83a9c9c5\">Cystourethrography</span> (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following should be the treatment of choice for renal cell carcinoma with a tumour less than 4 cm in size?", "options": [{"label": "A", "text": "Partial nephrectomy", "correct": true}, {"label": "B", "text": "Partial nephrectomy + Neoadjuvant chemotherapy", "correct": false}, {"label": "C", "text": "Radical nephrectomy", "correct": false}, {"label": "D", "text": "Radical nephrectomy + Postoperative radiotherapy", "correct": false}], "correct_answer": "A. Partial nephrectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Partial nephrectomy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of RCC: RCCs are radio and chemo-resistant (Option B &amp; D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">Nephrectomy</span> (Option A): </strong>Involves removing only the tumour while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</p>\n<p><strong>Indications: </strong>Larger tumours or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and <span class=\"customMeta\" data-dictid=\"ef32d1f4571692777185565852b47f\">Cryoablation</span> </strong>involve destroying the tumour using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumours (T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presented to his primary care physician with a 3-month history of increasing urinary frequency without burning and nocturia four times each day. He has limited his fluid consumption and caffeine intake in the evening without much benefit. On prostate examination, the swelling was palpated with a smooth surface, and a firm, non-tender rubber-like consistency was found. The physician thinks of benign prostate hypertrophy. All are characteristic features of benign prostate hypertrophy except:", "options": [{"label": "A", "text": "Increased trabeculations in the bladder", "correct": true}, {"label": "B", "text": "J-shaped/ fish hook proximal ureter", "correct": false}, {"label": "C", "text": "J-shaped/ fish hook distal ureters", "correct": false}, {"label": "D", "text": "Bilateral hydronephrosis", "correct": false}], "correct_answer": "A. Increased trabeculations in the bladder", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Benign <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> (BPH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age affected: <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">Men</span> over 50 years</li>\n<li>After 60 years, 50% of <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> have <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> evidence of BPH.</li>\n<li>Common cause of significant lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> symptoms (LUTS) in men: BPH</li>\n<li>Common cause of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (BOO) in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> more than 70 years of age: BPH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Role of hormones in BPH:</strong>\n<ul>\n<li><strong>DHT (Dihydrotestosterone)</strong>\n<ul>\n<li>DHT, derived from <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> via 5-alpha reductase, binds to <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> receptors in the prostate, promoting <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and contributing to prostatic enlargement.</li>\n</ul>\n</li>\n<li><strong>Estrogen</strong>\n<ul>\n<li>Estrogen levels increase relative to <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> in ageing men, influencing <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> growth through the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors, particularly ER-α, in the prostatic tissue.</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>Affects both <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> to variable degrees.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common site of origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Submucosal glands of the <span class=\"customMeta\" data-dictid=\"9f0c1a99081692777195efa0fd76d0\">periurethral</span> <strong>transitional zone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary changes in the bladder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is due to increased force of <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of <span class=\"customMeta\" data-dictid=\"80d318a6701692777186805934d86a\">detrusor</span> muscles):</p>\n<ul>\n<li>Collagen deposition</li>\n<li>Detrusor muscle hyperplasia</li>\n<li>Detrusor muscle hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Obstructive symptoms:</strong>\n<ul>\n<li>Poor flow/stream</li>\n<li>Hesitancy</li>\n<li>Intermittency</li>\n<li>Incomplete voiding-High post-void <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> urine</li>\n<li>Dribbling of urine</li>\n</ul>\n</li>\n<li><strong>Irritative symptoms:</strong>\n<ul>\n<li>Frequency</li>\n<li>Urgency</li>\n<li>Nocturia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Retention</li>\n<li>Haematuria</li>\n<li>Urinary infection</li>\n<li>Stone formation</li>\n<li>Hydronephrosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents to OPD with a low backache. His PSA level is 100 ng/ml. Which of the following drugs is indicated for treatment?", "options": [{"label": "A", "text": "Somatostatin", "correct": false}, {"label": "B", "text": "Terlipressin", "correct": false}, {"label": "C", "text": "Goserelin", "correct": true}, {"label": "D", "text": "Testosterone", "correct": false}], "correct_answer": "C. Goserelin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CA <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Active Surveillance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For low-risk cases; regular monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical Prostatectomy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiation Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-energy rays; external or brachytherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormone Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces/block testosterone; for advanced/metastatic cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic drug treatment; for advanced/metastatic cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old morbidly obese male patient presented with complaints of severe abdominal pain and urinary disturbances. His urine microscopy shows the following type of crystals, and an ultrasound of the kidney revealed a renal stone of size 2.5 cm. What is the treatment of choice?", "options": [{"label": "A", "text": "Extracorporeal shockwave lithotripsy (ESWL)", "correct": false}, {"label": "B", "text": "Percutaneous nephrolithotomy (PCNL", "correct": true}, {"label": "C", "text": "Open surgery", "correct": false}, {"label": "D", "text": "Ureteroscopy-assisted removal", "correct": false}], "correct_answer": "B. Percutaneous nephrolithotomy (PCNL", "question_images": ["https://image.prepladder.com/content/CRSE7iYKkoQg7He2UqDu1746984644.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Analgesics</strong> like diclofenac, ketorolac, tramadol</li>\n<li><strong>Fluid therapy:</strong> IVF (intravenous fluids) are administered to prevent dehydration</li>\n<li><strong>Alpha 1 blocker:</strong> Tamsulosin (relaxes <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and expels the stone).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Extracorporeal shock wave <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> (ESWL): </strong>Indicated if the size of the calculi<strong> &lt;2 cm</strong>. <strong>(Contraindicated in pregnancy and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> diathesis)</strong>.<strong> (Option A ruled out)</strong></li>\n<li><strong>PCNL (Percutaneous nephrolithotomy): </strong>If the size is <strong>&gt;2 cm</strong>. <strong>(Option B)</strong></li>\n<li><strong>Ureteroscopy </strong></li>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"544d770dfc1692777190622242d004\">intrarenal</span> surgery</strong></li>\n<li>Pyelolithotomy and <span class=\"customMeta\" data-dictid=\"5dda24df28169277719383e298df18\">nephrolithotomy</span> (rarely used).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to Weigert Meyer’s rule of duplication of the ureter, the lower pole ureter in the urinary bladder is:", "options": [{"label": "A", "text": "Lateral and cephalad to the upper pole ureter", "correct": true}, {"label": "B", "text": "Lateral and caudal to the upper pole ureter", "correct": false}, {"label": "C", "text": "Medial and cephalad to the upper pole ureter", "correct": false}, {"label": "D", "text": "Medial and caudal to the upper pole ureter", "correct": false}], "correct_answer": "A. Lateral and cephalad to the upper pole ureter", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man suffered a blow on a distended bladder ,following which he developed sudden severe pain in the hypogastrium associated with syncope. Later on, as the pain subsided, the abdomen began to distend. However, he had no desire to micturate. Which among the following is true regarding his condition?", "options": [{"label": "A", "text": "This is a typical case of extraperitoneal bladder rupture", "correct": true}, {"label": "B", "text": "MRI is the ideal investigation to diagnose bladder rupture", "correct": false}, {"label": "C", "text": "Repair is done by suturing edges with single-layer 2/0 absorbable suture", "correct": false}, {"label": "D", "text": "Laparoscopic method is avoided as it can be done only on laparotomy", "correct": false}], "correct_answer": "A. This is a typical case of extraperitoneal bladder rupture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0Wrut7Mp5YHjNS8t9JWb1747024432.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Extra peritoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It occurs when the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> wall is disrupted, but the peritoneal lining remains intact, often due to trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT cystography</strong> reveals characteristic features like a <strong>flame-shaped appearance, pear sign &amp; teardrop appearance.</strong></li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ali Nourian\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/bladder-rupture-5\" data-tags=\"\" height=\"722\" src=\"https://image.prepladder.com/content/0Wrut7Mp5YHjNS8t9JWb1747024432.png\" width=\"520\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Retrograde cystography</strong> is the <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> of choice for diagnosing <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> ruptures, including <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> injuries.</li>\n<li><strong>Extravasation of contrast limited to the <span class=\"customMeta\" data-dictid=\"a8676d7c5116927771959fe0c9087b\">perivesical</span> space is a key finding</strong> that helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> from <span class=\"customMeta\" data-dictid=\"e47e248094169277719000b0ed02ea\">intraperitoneal</span> ruptures, where contrast would outline <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial management:</strong>\n<ul>\n<li>Urethral catheterisation with free <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for 10-14 days.</li>\n<li>Followed by a <span class=\"customMeta\" data-dictid=\"b933eec07e1692777185b18d537acd\">cystogram</span> to confirm <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> before <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> removal.</li>\n</ul>\n</li>\n<li><strong>If the injury is iatrogenic:</strong>\n<ul>\n<li>Repair during the same procedure (open or laparoscopic).</li>\n<li>Repair done in <strong>two layers using 2/0 <span class=\"customMeta\" data-dictid=\"5292eb7fdc16927772020ce135cbdc\">vicryl</span> <span class=\"customMeta\" data-dictid=\"330e2bf7d216927771804326d05181\">absorbable</span> sutures (Option C ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Bladder injury with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fracture:</strong>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> should be repaired at the same time during the surgery for <strong>pelvic fracture.</strong></li>\n<li><strong>Immediate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair is indeed indicated</strong> in cases where there are <strong>complicating factors like <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> bone spicules, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck injuries</strong>, or associated <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> or rectal lacerations.</li>\n<li><strong>Laparoscopy</strong> can be used in the management of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture, particularly in cases where less <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> approaches are preferred <strong>(Option D ruled out)</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 11-month-old boy had a recent urinary tract infection that was resolved with antibiotics. Vital signs are within normal limits. Physical examination revealed an empty scrotum on the right side with normal left testis. However, a mass was palpable on the right inguinal canal. The USG revealed the right testicle under the subcutaneous fat near the right inguinal canal, as shown in the image below. What is the next best step in management?", "options": [{"label": "A", "text": "Observation", "correct": false}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "Orchidopexy", "correct": false}, {"label": "D", "text": "Surgical exploration", "correct": true}], "correct_answer": "D. Surgical exploration", "question_images": ["https://image.prepladder.com/notes/LG8bH4asDFJdwtPaVzu51747998560.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inguinal/Palpable</strong> undescended testis: 80%</li>\n<li><strong>Abdominal/Non-Palpable </strong>undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration. <strong>(Option D)</strong></li>\n<li><strong>Non-Palpable undescended testis:</strong> Diagnostic laparoscopy. <strong>(Option B ruled out)</strong></li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or MRI may be utilised to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Repositioning (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old. <strong>(Option C ruled out)</strong></p>\n<p> </p>\n<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with a low backache and weight loss. He has progressive difficulty in urination and had an episode of urinary retention two days back, which was relieved by catheterisation. PSA was done, which was 5.2 ng/ml, and an x-ray of the LS spine showed osteoblastic changes. What is the clinical diagnosis?", "options": [{"label": "A", "text": "Benign prostatic hypertrophy", "correct": false}, {"label": "B", "text": "Carcinoma bladder", "correct": false}, {"label": "C", "text": "Prostate cancer", "correct": true}, {"label": "D", "text": "Renal cell cancer", "correct": false}], "correct_answer": "C. Prostate cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations for <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DRE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physical examination detects nodules but is limited in early-stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PSA Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measures PSA levels; elevated levels suggest cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TRUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging with the rectal <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> detects abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>mpMRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Advanced imaging; superior for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> and capsular spread</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prostate Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The gold standard for diagnosis; tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> for cancer cells</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the initial course of action for a patient who has presented with a pelvic fracture and a rupture in the membranous urethra?", "options": [{"label": "A", "text": "A suprapubic catheter should be inserted as soon as possible", "correct": true}, {"label": "B", "text": "IVP should be done", "correct": false}, {"label": "C", "text": "Immediate urethroplasty", "correct": false}, {"label": "D", "text": "MCU should be done", "correct": false}], "correct_answer": "A. A suprapubic catheter should be inserted as soon as possible", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations, Management &amp; Complications of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Urethral Injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde Urethrography (RGU): Gold standard for initial assessment</strong></li>\n<li><strong>CT Urethrography</strong>: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li><strong>Cystoscopy: </strong>Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- <strong>Pie in-sky appearance</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Management:</strong> <strong>Suprapubic catheterisation for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> diversion</strong></li>\n<li><strong>Delayed Urethroplasty (Definitive management):</strong> 3-6 months post-injury after <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> have subsided <strong>(Option B ruled out)</strong></li>\n<li><strong>Primary Realignment:</strong> Occasionally attempted if conditions permit</li>\n<li><strong>Endoscopic Realignment:</strong> For selected cases, though often reserved for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Urethral <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> </strong>(most common long-term complication)</li>\n<li><strong>Urinary incontinence</strong> (due to <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> damage)</li>\n<li><strong>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> </strong>(common due to injury near <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> structures)</li>\n<li><strong>Bladder neck contracture</strong></li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> syndrome</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of the following appearance in IVP?", "options": [{"label": "A", "text": "Horseshoe kidney", "correct": false}, {"label": "B", "text": "Ureterocoele", "correct": true}, {"label": "C", "text": "Bladder tumour", "correct": false}, {"label": "D", "text": "Posterior urethral valve", "correct": false}], "correct_answer": "B. Ureterocoele", "question_images": ["https://image.prepladder.com/content/5nz06qI9NvZRvGWxJYIR1747115096.png"], "explanation_images": ["https://image.prepladder.com/content/8TrBBDPK2yViWmRWU1YN1747115130.png", "https://image.prepladder.com/content/HiVBjgtcldX1iOU3tREB1747115130.png", "https://image.prepladder.com/content/m74wB59sW33x9YUb9Kvi1748160399.png", "https://image.prepladder.com/content/Jui3HCafooMDBRhMRrmd1748160427.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ureterocoele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">Ureterocele</span> </strong>(Intravesical - 20%): Found entirely within the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and associated with a single ureter. It is less complex and easier to manage.</li>\n<li><strong>Ectopic <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">Ureterocele</span> </strong>(80%)<strong>:</strong> Extends beyond the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and often involves a duplicated ureter. This is more complicated due to its location, which may involve the bladder, neck, or urethra.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> is caused by an <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the development of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth, leading to <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> at the ureteral orifice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Infections (UTIs)/ Urosepsis.</li>\n<li>Unilateral Hydroureteronephrosis.</li>\n<li>Palpable Abdominal Mass: Particularly in children, where a distended <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> or large <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">ureterocele</span> might be felt as a mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound (USG):</strong> The first-line <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> revealing <span class=\"customMeta\" data-dictid=\"45d418d3f61692777189bccae8e1ca\">hydroureteronephrosis</span> and a <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure in the bladder.</li>\n<li><strong>Micturating Cystourethrogram (MCU):</strong> Demonstrates a <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> caused by the ureterocele.</li>\n<li><strong>Cystoscopy:</strong> Allows direct visualisation of the <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">ureterocele</span> as a <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure that enlarges and collapses with <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> flow in the bladder.</li>\n<li><strong>Intravenous Pyelogram (IVP):</strong> The <strong>investigation of choice</strong> (IOC) for diagnosing ureterocele, showing the characteristic <strong>\"adder head\" or \"cobra head\" appearance</strong> due to the dilated <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> within the bladder.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/8TrBBDPK2yViWmRWU1YN1747115130.png\" width=\"388\"/></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Evangelou K, Elfeky M\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/cobra-head-sign-ureter\" data-tags=\"\" height=\"479\" src=\"https://image.prepladder.com/content/HiVBjgtcldX1iOU3tREB1747115130.png\" width=\"394\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Cobra head or adder head appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The treatment approach depends on the type of ureterocele:</p>\n<ul>\n<li><strong>Intravesical Ureterocele:</strong> Typically managed with an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall to allow free flow of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> into the bladder, relieving the obstruction.</li>\n<li><strong>Ectopic Ureterocele:</strong> More complex, often requiring <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">ureterocele</span> and <span class=\"customMeta\" data-dictid=\"c6c1d34cf81692777197049241e98d\">reimplantation</span> of the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> into the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to correct the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> anatomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> of the upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> is <strong>ureteral duplication</strong>, which can be associated with ureterocele.</li>\n<li><strong>Vesicoureteric <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> (VUR)</strong>, another common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> abnormality, may occur in conjunction with ureterocele, particularly in cases involving ureteral duplication.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man developed abdominal pain for which he was being evaluated. You notice the following in his CECT. What is the likely condition indicated by the arrow in the image?", "options": [{"label": "A", "text": "Appendicitis", "correct": false}, {"label": "B", "text": "Horseshoe kidney", "correct": true}, {"label": "C", "text": "Wilms tumor", "correct": false}, {"label": "D", "text": "Abdominal aortic aneurysm", "correct": false}], "correct_answer": "B. Horseshoe kidney", "question_images": ["https://image.prepladder.com/content/JYn1HbkPFZaG9u6dVUQt1748162721.png"], "explanation_images": ["https://image.prepladder.com/content/Uf6qIkrBYlM1isdc7tJ31747115233.png", "https://image.prepladder.com/content/SDf42wkx49viv6xM1Ijo1747115236.png", "https://image.prepladder.com/content/ySFk9LVDDO22NFI8YbOS1748162634.png", "https://image.prepladder.com/content/OWfCub9YgiAmCcEexA1L1747115251.png", "https://image.prepladder.com/content/AXUz9y52y0dI6mH510ID1747115215.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Horseshoe kidney</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>During <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development, the kidneys <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> at their lower poles, forming a U-shaped structure.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> results in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> preventing the ascent of the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> to its normal position in the abdomen, leading to an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> location lower in the abdomen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mostly<strong> </strong>asymptomatic.</li>\n</ul>\n<ul>\n<li>Pain: due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs).</li>\n<li>Hydronephrosis.</li>\n<li>Hematuria</li>\n<li><strong>Rovsing's syndrome:</strong> Hyperextension of the spine- nausea, vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT Angiography (CT Angio):</strong> This is the <strong>investigation of choice</strong> for diagnosing a horseshoe kidney, as it allows for detailed visualisation of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> anatomy, the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> supply, and associated complications.</li>\n<li><strong>Contrast-Enhanced CT (CECT): </strong>Used when CT Angio is not available</li>\n<li><strong>Intravenous Pyelogram (IVP) - </strong>characteristic findings include<strong>:</strong>\n<ul>\n<li>Medial Orientation of Calyces: Referred to as the \"<strong>Hand Joining Sign.\"</strong></li>\n</ul>\n</li>\n</ul>\n<p>High Insertion of Ureters with Anterior Transposition: This creates a <strong>\"Flower Vase\" appearance of the ureters.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Aditya Shetty\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/horseshoe-kidney-intravenous-urogram\" data-tags=\"\" height=\"410\" src=\"https://image.prepladder.com/content/Uf6qIkrBYlM1isdc7tJ31747115233.png\" width=\"323\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Natsis, Konstantinos &amp; Piagkou, Maria &amp; Skotsimara, Antonia &amp; Protogerou, Vassilis &amp; Tsitouridis, Ioannis &amp; Skandalakis, Panagiotis. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/ntravenous-pyelogram-IVP-in-a-male-patient-demonstrating-a-horseshoe-kidney_fig2_277016641\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/SDf42wkx49viv6xM1Ijo1747115236.png\" width=\"294\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment depends on the presence and severity of symptoms:</p>\n<ul>\n<li><strong>Asymptomatic Patients:</strong> Typically do not require treatment but should be monitored periodically.</li>\n<li><strong>Symptomatic Patients:</strong>\n<ul>\n<li><strong>UPJ Obstruction:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention such as pyeloplasty</li>\n<li><strong>Kidney Stones:</strong> Management may include conservative measures like increased fluid intake, medical therapy, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal</li>\n<li><strong>UTIs:</strong> Treated with antibiotics, and <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> measures may be considered if infections are recurrent.</li>\n<li><strong>Isthmus Management:</strong> The <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> should not be divided surgically as it contains functional <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tissue.</li>\n<li><strong>Pregnancy Considerations:</strong> A <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> can lead to <span class=\"customMeta\" data-dictid=\"e700acb813169277718658466e6e33\">dystocia</span> (difficult labour) due to the kidney's <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> position.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who visited the outpatient department (OPD) experiencing intense pain during erection and a deviated penis for the past half-year?", "options": [{"label": "A", "text": "Peyronie’s disease", "correct": true}, {"label": "B", "text": "Priapism", "correct": false}, {"label": "C", "text": "Marion’s disease", "correct": false}, {"label": "D", "text": "Erectile dysfunction", "correct": false}], "correct_answer": "A. Peyronie’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v3wwtbg2wvGYksCuIaCU1748162864.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Peyronie’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterised by <strong>fibrous plaques in the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> <span class=\"customMeta\" data-dictid=\"31f0ff95651692777181fcca56acfe\">albuginea</span> of the penis,</strong> causing <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> during erections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plaque Location: Typically on the <span class=\"customMeta\" data-dictid=\"4c94b3faab16927771861e13308510\">dorsolateral</span> aspect of the penis.</strong></p>\n<p><strong>Curvature:</strong> Resulting from <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> contraction.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Charles Turner\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Charles Turner\" data-tags=\"\" height=\"710\" src=\"https://image.prepladder.com/content/v3wwtbg2wvGYksCuIaCU1748162864.png\" width=\"1164\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma/Injury: Repeated minor trauma to the penis.</li>\n<li>Genetic Factors: Possible genetic predisposition.</li>\n<li><strong>Connective Tissue Disorders:</strong> Associated with conditions like <strong>Dupuytren’s contracture.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galezia’s Triad:</strong></p>\n<ul>\n<li><strong>Dupuytren’s Contracture:</strong> Thickening and shortening of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue in fingers.</li>\n<li><strong>Retroperitoneal Fibrosis:</strong> Fibrosis in the <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> space.</li>\n<li><strong>Peyronie’s Disease</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painful Erection</li>\n<li>Erectile Dysfunction</li>\n<li>Penile Curvature</li>\n<li>Palpable Plaques</li>\n<li>Impotence &amp; Infertility (in severe cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Observation:</strong></p>\n<ul>\n<li>Spontaneous Resolution: Often improves without treatment.</li>\n</ul>\n<p><strong>Medical Management:</strong></p>\n<ul>\n<li><strong>Oral Medications: </strong>Pentoxifylline, colchicine, vitamin E (efficacy varies).</li>\n</ul>\n<p><strong>Surgical Intervention </strong>(If Spontaneous Resolution Does Not Occur):</p>\n<ul>\n<li><strong>Nesbit Operation:</strong> Placement of a non-absorbable <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> opposite the <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> to correct the curvature.</li>\n<li>Plication Surgery: Shortens the longer side of the penis.</li>\n<li>Plaque Excision and Grafting: Removes <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> and replaces it with <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> material.</li>\n<li>Penile Prosthesis: For severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis based on the X-ray given below?", "options": [{"label": "A", "text": "Renal calculi", "correct": false}, {"label": "B", "text": "Bladder calculi", "correct": true}, {"label": "C", "text": "Schistosomiasis", "correct": false}, {"label": "D", "text": "Ureteric calculi", "correct": false}], "correct_answer": "B. Bladder calculi", "question_images": ["https://image.prepladder.com/content/7kqNxP5FKPTLXRkfUCq91747116785.png"], "explanation_images": ["https://image.prepladder.com/content/VrrtQQesaqmKM3JxWpZB1747116812.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Secondary <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Stones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nutritional <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (Vitamins A, B6, magnesium, protein-carbohydrate imbalance)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bladder outlet obstruction, infection, foreign body presence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ammonium urate, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> oxalate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uric acid, <span class=\"customMeta\" data-dictid=\"0f125a33661692777199eec6125223\">struvite</span> (infection-related)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children in developing countries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adults with <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> or infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or present with dysuria, hematuria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematuria, dysuria, frequency and urgency,</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A simple X-ray, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or CT scan</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient undergoes TURP, and after 3 days, the patient develops altered sensitiveness and drowsiness. The most probable diagnosis is:", "options": [{"label": "A", "text": "Hypernatremia", "correct": false}, {"label": "B", "text": "Hyponatremia", "correct": true}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Meningitis due to spinal anaesthesia", "correct": false}], "correct_answer": "B. Hyponatremia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>TURP Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is because fluid is absorbed intravascularly due to high volumes of <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> <span class=\"customMeta\" data-dictid=\"ea6a429a6b1692777190801502ba55\">irrigation</span> fluid used during the resection, causing <span class=\"customMeta\" data-dictid=\"306696ad491692777186226c17193f\">dilutional hyponatremia</span> and various neurologic symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Size of <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> &gt; 75g</li>\n<li>Duration of surgery &gt; 90 minutes</li>\n<li>Pre-existing hyponatremia</li>\n<li>Renal failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confusion,</li>\n<li>Agitation,</li>\n<li>Nervousness,</li>\n<li>Nausea,</li>\n<li>Hemolysis,</li>\n<li>Visual disturbances,</li>\n<li>Coma and shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drug of choice: <strong>IV furosemide.</strong></li>\n<li><strong>Mild to moderate cases:</strong> IV <span class=\"customMeta\" data-dictid=\"b1527c07251692777203d317fb2eb0\">furosemide</span> and normal saline</li>\n<li><strong>Severe or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients:</strong> IV 3% Saline</li>\n<li>Fluid restriction: Useful after initial stabilisation and <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of severe <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> to prevent further fluid overload.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended initial investigation for genital tuberculosis?", "options": [{"label": "A", "text": "Endometrial biopsy", "correct": false}, {"label": "B", "text": "Urine sample for acid-fast bacilli (AFB) culture", "correct": false}, {"label": "C", "text": "Genital swab for polymerase chain reaction (PCR) testing", "correct": true}, {"label": "D", "text": "Chest X-ray", "correct": false}], "correct_answer": "C. Genital swab for polymerase chain reaction (PCR) testing", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<th>Topic</th>\n<th>Genital Tuberculosis</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Definition</td>\n<td>Genital <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> is a <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (TB) that affects the <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> organs, including the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes, uterus, ovaries, and male <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract. It results from the spread of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> bacteria to the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> organs from the primary site of infection (usually the lungs).</td>\n</tr>\n<tr>\n<td>Causative Agent</td>\n<td>Mycobacterium tuberculosis, the <span class=\"customMeta\" data-dictid=\"ff3e9793d01692777182b598b4a090\">bacterium</span> responsible for tuberculosis, causes <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tuberculosis. It is transmitted through <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> of <span class=\"customMeta\" data-dictid=\"5a986778421692777180f5f9dd3ea8\">airborne</span> droplets containing the bacteria. The bacteria can spread from the lungs to other organs, including the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract, through the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> or <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> system.</td>\n</tr>\n<tr>\n<td>Clinical Presentation</td>\n<td>- In females: <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> pain, <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> irregularities, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge, and <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> (due to <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube involvement).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- In males: Scrotal pain, testicular swelling, and <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> (due to epididymal or <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">vas</span> <span class=\"customMeta\" data-dictid=\"c8e17879f71692777185360caf5372\">deferens</span> involvement).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Both sexes may present with constitutional symptoms such as fatigue, weight loss, and night sweats.</td>\n</tr>\n<tr>\n<td>Risk Factors</td>\n<td>- Close contact with active <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> cases.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">Immunocompromised</span> individuals (e.g., HIV/AIDS patients).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Poor living conditions and overcrowding.</td>\n</tr>\n<tr>\n<td>Diagnosis</td>\n<td>- <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> <span class=\"customMeta\" data-dictid=\"b76c34e672169277719964ab6c1b56\">swab</span> or <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> chain reaction (PCR) testing to detect <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> DNA.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Histopathological examination of <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> samples to identify granulomas (a characteristic finding in tuberculosis).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> studies (ultrasound, hysterosalpingography, or scrotal ultrasound) to assess the extent of <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> organ involvement.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>Genital <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> is treated with standard anti-tuberculosis drug regimens, which typically include a combination of rifampicin, isoniazid, pyrazinamide, and ethambutol. Treatment duration may last several months to a year, depending on the severity of the disease and the response to therapy.</td>\n</tr>\n<tr>\n<td>Complications</td>\n<td>- <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">Infertility</span> due to <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or damage in females, and obstructive <span class=\"customMeta\" data-dictid=\"30e3cd418e16927771829a413730c2\">azoospermia</span> (absence of <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> in semen) in males.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain and scrotal discomfort.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Rarely, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> can lead to <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> fistulas, which are <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> connections between organs.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "62 year old female has kidney stone and treated with PCNL. After 2 days she again comes to OPD with chills and fever. What is the complication?", "options": [{"label": "A", "text": "Acute pancreatitis", "correct": false}, {"label": "B", "text": "Splenic injury", "correct": false}, {"label": "C", "text": "Ureteric Stricture", "correct": false}, {"label": "D", "text": "Bacterial Sepsis", "correct": true}], "correct_answer": "D. Bacterial Sepsis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Bacterial S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial management approach for urinary symptoms in a patient with benign prostatic hyperplasia (BPH) ?", "options": [{"label": "A", "text": "TURP: Transurethral resection of prostate", "correct": false}, {"label": "B", "text": "Tamsulosin", "correct": true}, {"label": "C", "text": "Finasteride", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Tamsulosin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Tamsu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient came to the outpatient department with complaints of hematuria . A 2x2 cm bladder mass is seen which is low grade transitional cell carcinoma . Which among the following is the ideal management?", "options": [{"label": "A", "text": "Transurethral resection of the tumor", "correct": true}, {"label": "B", "text": "Resection with ileal conduit", "correct": false}, {"label": "C", "text": "Partial cystectomy with bladder reconstruction", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy", "correct": false}], "correct_answer": "A. Transurethral resection of the tumor", "question_images": ["https://image.prepladder.com/content/UfvCfyMULVTg5LA1D9Ke1713852153.png"], "explanation_images": [], "explanation": "<p>Correct option A - Transurethral &lt;span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\"&gt;resection&lt;/span&gt; of the tumou\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p>Tis (malignant cystitis)</p>\n</td>\n<td>\n<p>Intravesical BCG</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ta (single, low to moderate grade, non-recurrent)</p>\n</td>\n<td>\n<p>Complete TUR</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ta (multiple, high grade, recurrent)</p>\n</td>\n<td>\n<p>Complete <span class=\"customMeta\" data-dictid=\"8666af58061692777201e6b596f0c9\">TUR</span> + <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">Intravesical</span> chemotherapy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T1</p>\n</td>\n<td>\n<p>Complete <span class=\"customMeta\" data-dictid=\"8666af58061692777201e6b596f0c9\">TUR</span> + <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">Intravesical</span> chemotherapy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T2 - T4</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Radical cystectomy</p>\n</li>\n<li>\n<p>Neoadjuvant <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> followed by radical cystectomy</p>\n</li>\n<li>\n<p>Radical <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> followed by <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> chemotherapy ± Radiotherapy</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old man was referred to the surgery OPD from the infertility clinic . On inspection, the scrotum appeared as in the image. On palpation, a bag of worm sensation was felt . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Varicocele", "correct": true}, {"label": "C", "text": "Testicular torsion", "correct": false}, {"label": "D", "text": "Epididymo Orchitis", "correct": false}], "correct_answer": "B. Varicocele", "question_images": ["https://image.prepladder.com/content/Tb3Ro1JcAmgUhc1C5njq1713960228.png"], "explanation_images": ["https://image.prepladder.com/content/6SN3Ttp4DA3LxreqjUtU1713851249.png", "https://image.prepladder.com/content/XwWMs4VHeKwxtmXtQikB1713851228.png"], "explanation": "<p>Correct Option B - V\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Clinical Presentation</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hydrocele</strong></p>\n</td>\n<td>\n<p>Collection of fluid within the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</td>\n<td>\n<p>Painless swelling feels like a smooth mass on palpation, may be transilluminated</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound</p>\n</td>\n<td>\n<p>Asymptomatic cases may be observed; surgery may be required for large or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> hydroceles</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Varicocele</strong></p>\n</td>\n<td>\n<p>Enlargement of veins within the scrotum</p>\n</td>\n<td>\n<p>Painless swelling, \"bag of worms\" sensation on palpation, usually left-sided</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound</p>\n</td>\n<td>\n<p>Surgical repair may be considered for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> varicoceles or for infertility</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Testicular Torsion</strong></p>\n</td>\n<td>\n<p>Twisting of the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td>\n<p>Acute onset of severe pain, swelling, testicular tenderness, nausea, vomiting</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound</p>\n</td>\n<td>\n<p>Emergency <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention is required to prevent testicular loss</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Epididymo- orchitis</strong></p>\n</td>\n<td>\n<p>Inflammation of the <span class=\"customMeta\" data-dictid=\"755b023ad31692777187f4c9bd10fb\">epididymis</span> and/or testis</p>\n</td>\n<td>\n<p>Pain, swelling, <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> of the scrotum, fever, discharge</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and blood tests</p>\n</td>\n<td>\n<p>Antibiotics, pain management, surgery in severe case</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are s torage symptoms of benign prostatic hyperplasia ? 1. Urgency 2. Enuresis 3. Hesitancy 4. Frequency 5. Dribbling", "options": [{"label": "A", "text": "1, 3, 4", "correct": false}, {"label": "B", "text": "2 and 5", "correct": false}, {"label": "C", "text": "1, 2, 4, 5", "correct": false}, {"label": "D", "text": "1, 2, 4", "correct": true}], "correct_answer": "D. 1, 2, 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 1, 2, 4\n<table style=\"width:692px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Storage Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Voiding Symptoms</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Urgency</strong>: A sudden, strong urge to <span class=\"customMeta\" data-dictid=\"c0b5bbe709169277720177f8c58ad5\">urinate</span> that may be difficult to suppress.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Hesitancy</strong>: Difficulty initiating urination, often characterized by a delay in the start of the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stream</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Enuresis</strong>: <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">Involuntary</span> leakage of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> during sleep.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Dribbling</strong>: Continued leakage of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> after the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stream has stopped.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Frequency</strong>: Need to <span class=\"customMeta\" data-dictid=\"c0b5bbe709169277720177f8c58ad5\">urinate</span> frequently, often more than 8 times a day.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Intermittency</strong>: <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> flow stops and starts during micturition.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Nocturia</strong>: Need to wake at night at least once to void.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Poor flow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Urgency <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">Incontinence</span> (UI)</strong>: <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">Involuntary</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> leakage, often large volume, immediately preceded by urgency.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Incomplete emptying</strong>: Sensation of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> fullness persisting at the end of micturition.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What diagnosis would you suggest for a 10-month-old male baby who presented with an empty scrotum , wherein ultrasonography showed the right testis located in the right inguinal canal and the left testis located in the perineum?", "options": [{"label": "A", "text": "Bilateral undescended testis", "correct": false}, {"label": "B", "text": "Bilateral ectopic testis", "correct": false}, {"label": "C", "text": "Right side undescended testis and left sided ectopic testis", "correct": true}, {"label": "D", "text": "Right side ectopic testis and left side undescended testis", "correct": false}], "correct_answer": "C. Right side undescended testis and left sided ectopic testis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rwAbshGevjTmjL7fAYBV1714546657.png", "https://image.prepladder.com/content/gqpHa2gFAEaVfShTwWBQ1714546628.png"], "explanation": "<p>Correct Option C - Right side undescended &lt;span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\"&gt;testis&lt;/span&gt; and left sided &lt;span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\"&gt;ectopic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the investigation and the lesion depicted in the image given below.", "options": [{"label": "A", "text": "Retrograde cystourethrogram with membranous urethra stricture", "correct": false}, {"label": "B", "text": "Retrograde cystourethrogram with penile urethral stricture", "correct": true}, {"label": "C", "text": "Micturating cystourethrography with bulbar stricture", "correct": false}, {"label": "D", "text": "Micturating cystourethrography with psoriatic urethra stricture", "correct": false}], "correct_answer": "B. Retrograde cystourethrogram with penile urethral stricture", "question_images": ["https://image.prepladder.com/content/X1L0ITtxtiN5cyyrjMCI1713356454.png"], "explanation_images": ["https://image.prepladder.com/content/Wb3FTFl4NL0OQTABwu0M1712230689.png"], "explanation": "<p>Correct Option B - Retrograde &lt;span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\"&gt;cystourethrogram&lt;/span&gt; with penile urethral strictu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the hospital with a history of increased frequency of micturition . On cystoscopy, a pale ureteric orifice was seen. The patient’s KUB x-ray is given below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Bladder carcinoma", "correct": false}, {"label": "B", "text": "Schistosomiasis", "correct": false}, {"label": "C", "text": "Bladder tuberculosis", "correct": true}, {"label": "D", "text": "Papilloma of urinary bladder", "correct": false}], "correct_answer": "C. Bladder tuberculosis", "question_images": ["https://image.prepladder.com/content/mSR9oD67hzgHu3slkUER1713960330.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\"&gt;Bladder&lt;/span&gt; tubercu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 77-year-old man presented with worsening hip and back pain . He also reports weight loss and loss of appetite . His PSA levels are elevated. What is the most likely diagnosis here?", "options": [{"label": "A", "text": "Ankylosing spondylitis", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": false}, {"label": "D", "text": "Prostate cancer", "correct": true}], "correct_answer": "D. Prostate cancer", "question_images": ["https://image.prepladder.com/content/z5A2j69HG5ya43ZQr8J21713960409.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient presents with palpitations, episodic headaches , and sweating episodes . Workup shows a small left-sided suprarenal mass . Which of the following would be done for confirmation?", "options": [{"label": "A", "text": "Urinary vanillyl mandelic acid levels", "correct": true}, {"label": "B", "text": "Blood 5-HIAA levels", "correct": false}, {"label": "C", "text": "Urine myoglobin", "correct": false}, {"label": "D", "text": "Stool trypsin levels", "correct": false}], "correct_answer": "A. Urinary vanillyl mandelic acid levels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Urinary vanillyl mandelic acid lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If radiotherapy is administered along with chemotherapy for bladder cancer, which drug's dosage should be decreased?", "options": [{"label": "A", "text": "Cisplatin", "correct": false}, {"label": "B", "text": "Gemcitabine", "correct": true}, {"label": "C", "text": "Paclitaxel", "correct": false}, {"label": "D", "text": "Ifosfamide", "correct": false}], "correct_answer": "B. Gemcitabine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is used for prostate cancer ?", "options": [{"label": "A", "text": "Gleason score", "correct": true}, {"label": "B", "text": "Bethesda score", "correct": false}, {"label": "C", "text": "Alvarado score", "correct": false}, {"label": "D", "text": "Nottingham score", "correct": false}], "correct_answer": "A. Gleason score", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1fXdi1bYTpMNK8CR515z1713235453.png"], "explanation": "<p>Correct Option A - G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After performing a diagnostic laparoscopy in a child with a unilateral undescended testis revealing blind-ending testicular vessels on the right side , what is the subsequent course of action?", "options": [{"label": "A", "text": "Inguinal exploration", "correct": false}, {"label": "B", "text": "Abdominal exploration", "correct": false}, {"label": "C", "text": "Scrotal exploration", "correct": false}, {"label": "D", "text": "Nothing to be done", "correct": true}], "correct_answer": "D. Nothing to be done", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Nothing\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Undescended Testis</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Prepubertal Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism)</p>\n</td>\n<td>\n<p>Testis that has not descended into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> by the age of 6 months to 1 year</p>\n</td>\n<td>\n<p>Observation: <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> may occur within the first year of life; If <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> remains undescended, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention is recommended</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Persistent Undescended Testis</p>\n</td>\n<td>\n<p>Testis that has not descended into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> beyond the age of 1 year</p>\n</td>\n<td>\n<p>Surgical Management: <span class=\"customMeta\" data-dictid=\"c15a653f471692777194abcf05f81a\">Orchidopexy</span> (orchiopexy) - <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> into the scrotum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Retractile Testis</p>\n</td>\n<td>\n<p>Testis that is intermittently elevated and descends into the scrotum</p>\n</td>\n<td>\n<p>Observation: No intervention is required as the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> can spontaneously descend into the scrotum; Education on testicular self-examination</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ectopic Testis</p>\n</td>\n<td>\n<p>Testis located in an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> position outside the normal <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> pathway</p>\n</td>\n<td>\n<p>Surgical Management: <span class=\"customMeta\" data-dictid=\"c15a653f471692777194abcf05f81a\">Orchidopexy</span> - <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> relocation of the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> to the scrotum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Absent or Atrophic Testis</p>\n</td>\n<td>\n<p>Complete absence of the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> or presence of an atrophic (non-functional) testis</p>\n</td>\n<td>\n<p>No <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention required; Documentation of findings and discussion with the patient and family</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Thimble bladder is seen in:", "options": [{"label": "A", "text": "Acute TB", "correct": false}, {"label": "B", "text": "Chronic TB", "correct": true}, {"label": "C", "text": "Neurogenic bladder", "correct": false}, {"label": "D", "text": "Schistosomiasis", "correct": false}], "correct_answer": "B. Chronic TB", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Chronic TB\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Prostate cancer most commonly seen in which zone:", "options": [{"label": "A", "text": "Central zone", "correct": false}, {"label": "B", "text": "Transition zone", "correct": false}, {"label": "C", "text": "Peripheral zone", "correct": true}, {"label": "D", "text": "Anterior fibromuscular stroma", "correct": false}], "correct_answer": "C. Peripheral zone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Periph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The hospital received a patient with varicose veins, and an intern was on duty. Which test should the intern conduct to exclude the possibility of deep vein thrombosis (DVT)?", "options": [{"label": "A", "text": "Brodie Tredelenberg test", "correct": false}, {"label": "B", "text": "Perthe’s test", "correct": true}, {"label": "C", "text": "Thomas test", "correct": false}, {"label": "D", "text": "Ober test", "correct": false}], "correct_answer": "B. Perthe’s test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Perth\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Components - I</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Components - II</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">Apply <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> and ask the patient to stand</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Remove <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">Tourniquet</span> in standing position</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Release the pressure</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Rapid <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> from above</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">It is suggestive of <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">Incompetent</span> SFJ</p>\n</td>\n<td>\n<p style=\"text-align:center\">Apply the tourniquet</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Ask the patient to stand</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Slow <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> from below</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">It is suggestive of <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">Incompetent</span> perforators</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where will the left kidney transplant be positioned ?", "options": [{"label": "A", "text": "Iliac fossa", "correct": true}, {"label": "B", "text": "Kidney fossa", "correct": false}, {"label": "C", "text": "Retroperitoneal space", "correct": false}, {"label": "D", "text": "Hypogastric region", "correct": false}], "correct_answer": "A. Iliac fossa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4cxVdkRoLw0qwVJHFcYw1714990766.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\"&gt;Iliac&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the abnormal condition given below:", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Varicocele", "correct": false}, {"label": "C", "text": "Testicular atrophy", "correct": false}, {"label": "D", "text": "Testicular Torsion", "correct": true}], "correct_answer": "D. Testicular Torsion", "question_images": ["https://image.prepladder.com/content/p8dCrcJU2k8g2BU2Lkc31695541356.png"], "explanation_images": ["https://image.prepladder.com/content/F2Rv4Jy5l4wKcblSGAxY1713259866.png"], "explanation": "<p>Correct Option D - Testicular T\n<table>\n<tbody>\n<tr>\n<td style=\"text-align:center\">\n<p><strong>Extra Vaginal</strong></p>\n</td>\n<td style=\"text-align:center\">\n<p><strong>Intra Vaginal</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Extra <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> occurs outside the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Torsion occurs within the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</li>\n<li>\n<p>Most common</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate treatment for a 40-year-old man experiencing scrotal heaviness, with the presence of a bag of worms observed during scrotal examination, and reduction in swelling observed in a supine position?", "options": [{"label": "A", "text": "Suction drainage", "correct": false}, {"label": "B", "text": "Varicocelectomy", "correct": true}, {"label": "C", "text": "Jaboulay procedure", "correct": false}, {"label": "D", "text": "Herniotomy", "correct": false}], "correct_answer": "B. Varicocelectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - V\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Predominantly osteoblastic secondaries are seen in which of the following?", "options": [{"label": "A", "text": "Prostate carcinoma", "correct": true}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Stomach carcinoma", "correct": false}, {"label": "D", "text": "Bone carcinoma", "correct": false}], "correct_answer": "A. Prostate carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\"&gt;Prostate&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs cause carcinoma bladder ?", "options": [{"label": "A", "text": "Cyclophosphamide", "correct": true}, {"label": "B", "text": "Cisplatin", "correct": false}, {"label": "C", "text": "Taxane", "correct": false}, {"label": "D", "text": "Tamoxifen", "correct": false}], "correct_answer": "A. Cyclophosphamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Cyclophosph\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transitional cell carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Squamous cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Smoking</p>\n<p>2. Drugs</p>\n<ul>\n<li>\n<p>Phenacetin</p>\n</li>\n<li>\n<p>Chlornaphazine</p>\n</li>\n<li>\n<p>Cyclophosphamide</p>\n</li>\n</ul>\n<p>3. Exposure of</p>\n<ul>\n<li>\n<p>Benzidine</p>\n</li>\n<li>\n<p>Hydrocarbon</p>\n</li>\n<li>\n<p>Aniline</p>\n</li>\n<li>\n<p>Acrolein</p>\n</li>\n<li>\n<p>Beta-naphthylamine</p>\n</li>\n</ul>\n<p>4. Printing, Dyeing, Rubber, Leather, Automobile &amp; <span class=\"customMeta\" data-dictid=\"784bd236b21692777195bf9eb52a33\">Petroleum</span> industries</p>\n<p>5. <span class=\"customMeta\" data-dictid=\"26cdc047771692777198466c58cdc6\">Schistosomiasis</span> (SSC &gt; TCC)</p>\n<p>6. <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> irradiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Schistosomiasis</p>\n<p>2. Chronic Inflammation</p>\n<ul>\n<li>\n<p>Bladder stone</p>\n</li>\n<li>\n<p>Bladder diverticulum</p>\n</li>\n<li>\n<p>Prolonged catheterization</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image shows the retrograde ureteropyelogram of a patient with loin pain. What is the most probable clinical diagnosis ?", "options": [{"label": "A", "text": "Hydronephrosis", "correct": true}, {"label": "B", "text": "Duplex kidney", "correct": false}, {"label": "C", "text": "Renal carcinoma", "correct": false}, {"label": "D", "text": "Renal stone", "correct": false}], "correct_answer": "A. Hydronephrosis", "question_images": ["https://image.prepladder.com/content/shKqhiy8h33nGigW7e581691498141.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hydroneph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is caused by the infection of protease ?", "options": [{"label": "A", "text": "Uric acid", "correct": false}, {"label": "B", "text": "Ammonium magnesium phosphate", "correct": true}, {"label": "C", "text": "Struvite", "correct": false}, {"label": "D", "text": "Calcium oxalate", "correct": false}], "correct_answer": "B. Ammonium magnesium phosphate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ammonium &lt;span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\"&gt;magnesium&lt;/span&gt; phosph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common organism causing acute bacterial prostatitis ?", "options": [{"label": "A", "text": "Enterococcus", "correct": false}, {"label": "B", "text": "Proteus", "correct": false}, {"label": "C", "text": "Streptococcus Agalacticia", "correct": false}, {"label": "D", "text": "E.coli", "correct": true}], "correct_answer": "D. E.coli", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - E.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most important determinant of malignant potential in the papillary type of renal tumor ?", "options": [{"label": "A", "text": "Immunohistology", "correct": false}, {"label": "B", "text": "Size", "correct": true}, {"label": "C", "text": "Cytogenetics", "correct": false}, {"label": "D", "text": "Part of kidney involved", "correct": false}], "correct_answer": "B. Size", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cut off for diagnosis of Priapism is ?", "options": [{"label": "A", "text": "1 hour", "correct": false}, {"label": "B", "text": "2 hours", "correct": false}, {"label": "C", "text": "3 hours", "correct": false}, {"label": "D", "text": "4 hours", "correct": true}], "correct_answer": "D. 4 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 4 hou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis ?", "options": [{"label": "A", "text": "ESWL", "correct": false}, {"label": "B", "text": "PCNL", "correct": true}, {"label": "C", "text": "Antegrae pyeloplasty", "correct": false}, {"label": "D", "text": "Retrograde pyeloplasty", "correct": false}], "correct_answer": "B. PCNL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PCNL\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a germ cell tumor not typically observed in males ?", "options": [{"label": "A", "text": "Choriocarcinoma", "correct": false}, {"label": "B", "text": "Seminoma", "correct": false}, {"label": "C", "text": "Sertoli cell tumour", "correct": true}, {"label": "D", "text": "Teratoma", "correct": false}], "correct_answer": "C. Sertoli cell tumour", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"ac8c26ed99169277719897b57e48b8\"&gt;Sertoli cell&lt;/span&gt; tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male came to the OPD with complaints of a painful erection without sexual drive . The patient also gives a history of taking antipsychotic medication. The cut-off duration for diagnosis of Priapism is:", "options": [{"label": "A", "text": "1 hour", "correct": false}, {"label": "B", "text": "2 hours", "correct": false}, {"label": "C", "text": "3 hours", "correct": false}, {"label": "D", "text": "4 hours", "correct": true}], "correct_answer": "D. 4 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 4 hou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bell clapper testis predisposes to:", "options": [{"label": "A", "text": "Torsion testis", "correct": true}, {"label": "B", "text": "Varicocele", "correct": false}, {"label": "C", "text": "Cancer of testis", "correct": false}, {"label": "D", "text": "Hydrocele", "correct": false}], "correct_answer": "A. Torsion testis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with Renal calculus of &amp;gt; 4 cm of the staghorn type . What is the best management?", "options": [{"label": "A", "text": "ESWL", "correct": false}, {"label": "B", "text": "Percutaneous Nephrolithotomy and ESWL", "correct": true}, {"label": "C", "text": "Ureteroscopic removal", "correct": false}, {"label": "D", "text": "Retro renal surgery", "correct": false}], "correct_answer": "B. Percutaneous Nephrolithotomy and ESWL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\"&gt;Percutaneous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"5dda24df28169277719383e298df18\"&gt;Nephrolithotomy&lt;/span&gt; and ESWL\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with pain and swelling in the right side of his scrotum and testicular torsion is suspected . Which is the most appropriate management?", "options": [{"label": "A", "text": "Immediate exploration on both symptomatic and asymptomatic side", "correct": true}, {"label": "B", "text": "Immediate exploration on symptomatic side only", "correct": false}, {"label": "C", "text": "Delayed exploration on both symptomatic and asymptomatic side", "correct": false}, {"label": "D", "text": "Delayed exploration on symptomatic side only", "correct": false}], "correct_answer": "A. Immediate exploration on both symptomatic and asymptomatic side", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Immediate exploration on both &lt;span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\"&gt;symptomatic&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\"&gt;asymptomatic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The type of renal calculi which is resistant to Extracorporeal Shock-Wave Lithotripsy (ESWL) is?", "options": [{"label": "A", "text": "Struvite", "correct": false}, {"label": "B", "text": "Cystine", "correct": true}, {"label": "C", "text": "Calcium oxalate dihydrate", "correct": false}, {"label": "D", "text": "Uric Acid", "correct": false}], "correct_answer": "B. Cystine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the appropriate next step in management for a 22-year-old male presenting with a painless, hard testicular swelling, along with the presence of inguinal, intra-abdominal, or mediastinal lymph nodes on CT scan , elevated AFP levels (&amp;gt; 3000) in blood investigations, and USG findings indicating uniform echotexture with small areas of necrosis?", "options": [{"label": "A", "text": "High inguinal orchidectomy", "correct": true}, {"label": "B", "text": "Core needle tract biopsy", "correct": false}, {"label": "C", "text": "FNAC", "correct": false}, {"label": "D", "text": "Whole body PET/CT", "correct": false}], "correct_answer": "A. High inguinal orchidectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - High inguinal orchidectomy: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 130 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "An elderly male is identified to have a well-circumscribed lesion within the prostate suspicious of cancer. Based on the McNeal classification, in which prostatic zone is the lesion most likely to be located?", "options": [{"label": "A", "text": "Transitional Zone", "correct": false}, {"label": "B", "text": "Peripheral Zone", "correct": true}, {"label": "C", "text": "Central Zone", "correct": false}, {"label": "D", "text": "Anterior Fibromuscular Stroma", "correct": false}], "correct_answer": "B. Peripheral Zone", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OkxNgMDhWY80nIw7A9dQ1740023128.png", "https://image.prepladder.com/content/GNj2PCGuJbPMr2X5Vk5J1740023152.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/C192W85sQ5QNJl5Y7iH11747236394.mp3", "video": ""}, {"text": "A 75-year-old man presents with difficulty in urination, weak stream, and increased frequency. On digital rectal examination, his prostate is found to be enlarged, and his PSA levels are mildly elevated. Which enzyme converts testosterone to dihydrotestosterone, a hormone responsible for the pathogenesis of his condition?", "options": [{"label": "A", "text": "Aromatase", "correct": false}, {"label": "B", "text": "17-β Hydroxysteroid dehydrogenase", "correct": false}, {"label": "C", "text": "5 𝛼 reductase", "correct": true}, {"label": "D", "text": "21-Hydroxylase", "correct": false}], "correct_answer": "C. 5 𝛼 reductase", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Enzyme</th>\n<th>Function</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>5-α Reductase</strong></td>\n<td>Converts <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> to DHT → promotes <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> growth</td>\n</tr>\n<tr>\n<td>Aromatase</td>\n<td>Converts androgens to estrogens</td>\n</tr>\n<tr>\n<td>17-β Hydroxysteroid DH</td>\n<td>Converts <span class=\"customMeta\" data-dictid=\"2b218bfcc816927771817d02ae5257\">androstenedione</span> ↔ testosterone; not involved in DHT production</td>\n</tr>\n<tr>\n<td>21-Hydroxylase</td>\n<td>Involved in cortisol/aldosterone synthesis, not <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> pathway</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/60wy65Ivm2p5mnYPJZcx1747236529.mp3", "video": ""}, {"text": "A 68-year-old male presents with complaints of urinary frequency, nocturia, and a weak urinary stream. The International Prostate Symptom Score (IPSS) assessment reveals a score of 22. Which of the following best describes the severity of his symptoms according to the IPSS?", "options": [{"label": "A", "text": "Mild", "correct": false}, {"label": "B", "text": "Moderate", "correct": false}, {"label": "C", "text": "Severe", "correct": true}, {"label": "D", "text": "Asymptomatic", "correct": false}], "correct_answer": "C. Severe", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:357px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>F</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>U</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urgency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nocturia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>W</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weak stream</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermittency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Straining</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>E</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensation of incomplete emptying</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UgiETEGMEnDXMJhvEaTj1747236646.mp3", "video": ""}, {"text": "A 65-year-old male presents with urinary frequency, nocturia, and a weak urinary stream for 6 months. His prostate is symmetrically enlarged, prostate-specific antigen (PSA) is slightly elevated and Qmax (Uroflowmetry) is 7 ml/sec. Which of the following is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Transurethral resection of the prostate", "correct": false}, {"label": "B", "text": "Tamsulosin", "correct": true}, {"label": "C", "text": "Immediate catheterization", "correct": false}, {"label": "D", "text": "Finasteride", "correct": false}], "correct_answer": "B. Tamsulosin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/O3YuVTUHg8wj2AGmfsrv1747236872.mp3", "video": ""}, {"text": "Which of the following is the most common complication of TURP (Trans urethral resection of prostate)?", "options": [{"label": "A", "text": "Retrograde ejaculation", "correct": true}, {"label": "B", "text": "TURP syndrome", "correct": false}, {"label": "C", "text": "Incontinence", "correct": false}, {"label": "D", "text": "Erectile dysfunction", "correct": false}], "correct_answer": "A. Retrograde ejaculation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2NFzEMkl6sSqBd7zHq1y1740023316.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monopolar TURP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bipolar TURP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irrigant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1% glycine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal saline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Time for resection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extended</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quality of hemostasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Energy/ voltage/ <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/d46Ws0pvcGi2srxaLXT41747237040.mp3", "video": ""}, {"text": "A 70-year-old man is undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. Postoperatively, he gets agitated and complains of severe headache, nausea, and blurred vision. His lab results show a serum sodium level of 118 mEq/L. Which of the following is the most appropriate initial management?", "options": [{"label": "A", "text": "Administer intravenous hypertonic saline", "correct": true}, {"label": "B", "text": "Start oral furosemide", "correct": false}, {"label": "C", "text": "Administer intravenous normal saline", "correct": false}, {"label": "D", "text": "Oral fluid restriction", "correct": false}], "correct_answer": "A. Administer intravenous hypertonic saline", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iYqmoWek7FZV1XpkG4dt1747237308.mp3", "video": ""}, {"text": "A 65-year-old male is undergoing surgery for Benign Prostatic Hyperplasia with distressing LUTS (lower urinary tract symptoms). Prostate gland is significantly enlarged, measuring over 100 grams. Which among the following surgical approach is most appropriate?", "options": [{"label": "A", "text": "Transurethral incision of prostate", "correct": false}, {"label": "B", "text": "Open prostatectomy", "correct": true}, {"label": "C", "text": "Frayer’s suprapubic prostatectomy", "correct": false}, {"label": "D", "text": "Young’s perineal prostatectomy", "correct": false}], "correct_answer": "B. Open prostatectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4fpjxRtDGT2X8amscM3z1747237913.mp3", "video": ""}, {"text": "A 55-year-old male, known diabetic presents to the emergency department with a high-grade fever, perineal pain, and difficulty urinating. He has a history of acute bacterial prostatitis, treated two weeks ago with antibiotics. On examination, the prostate is tender and swollen. What is the most likely diagnosis and investigation to confirm the same?", "options": [{"label": "A", "text": "Prostatic abscess and Transrectal ultrasound", "correct": true}, {"label": "B", "text": "Chronic prostatitis and urine culture", "correct": false}, {"label": "C", "text": "Acute prostatitis and urine microscopy", "correct": false}, {"label": "D", "text": "Benign prostatic hyperplasia and PSA levels", "correct": false}], "correct_answer": "A. Prostatic abscess and Transrectal ultrasound", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute bacterial prostatitis</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"9c6787167d169277718231792156e2\">bacterial prostatitis</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prostatic abscess</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of prostate.</li>\n<li>Risk factor- STI, prolonged <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> and instrumentation.</li>\n<li>Gram-negative bacteria, enterobacteriaceae</li>\n<li>Common organism- E. coli</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Development of bacterial biofilms.</li>\n<li>Enterobacteriaceae</li>\n<li>Common organism- E. coli</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complication of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> bacterial prostatitis</li>\n<li>High risk:\n\t\t\t\t<ul>\n<li>Immunocompromised people</li>\n<li>Diabetes</li>\n<li>Chronic catheterization</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever, chills, rigor</li>\n<li>Back pain</li>\n<li>Perineal pain/ heaviness</li>\n<li>Pain on defecation</li>\n<li>Associated <span class=\"customMeta\" data-dictid=\"210e94f8861692777201a0d6de4b0e\">UTI</span> symptoms</li>\n<li>DRE: Tender, enlarged</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Persistent infection of <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> attacks of UTI</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever, chills, rigor</li>\n<li>Back pain</li>\n<li>Perineal pain/ heaviness</li>\n<li>DRE: Tender, swollen prostate, positive fluctuation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urine routine and culture</li>\n<li>Transrectal US and CT <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to rule out <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> in high-risk patients</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microscopy and culture of prostatic expresate and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> taken before and prostatic massage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Transrectal US</strong> and CT pelvis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolonged antibiotics</li>\n<li>Trimethoprim, ciprofloxacin, or <span class=\"customMeta\" data-dictid=\"0291b75d1416927771817e25f028c9\">aminoglycoside</span> for 4 to 6 weeks to prevent chronic prostatitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics for 3-4 months based on culture.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trans urethral drainage</li>\n<li>IV Antibiotics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dryHedw7l7RTpUSnJrwX1747241077.mp3", "video": ""}, {"text": "A 60-year-old male undergoes evaluation for a urinary tract infection. Imaging studies reveal multiple small stones within the prostate gland. Laboratory analysis of these prostatic calculi will most likely show which of the following compositions?", "options": [{"label": "A", "text": "Uric acid", "correct": false}, {"label": "B", "text": "Struvite", "correct": false}, {"label": "C", "text": "Calcium oxalate", "correct": false}, {"label": "D", "text": "Calcium phosphate", "correct": true}], "correct_answer": "D. Calcium phosphate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JRnn7NWVE1aWJr2embK91740023542.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ip4Zg0EXO9p6xTukYarg1747241238.mp3", "video": ""}, {"text": "An elderly male presents with urinary hesitancy, weak stream, nocturia, weight loss, and back pain. DRE reveals a hard, irregular prostate. Which of the following is the common genetic alteration observed in his condition?", "options": [{"label": "A", "text": "Mutation of the BRCA1 gene", "correct": false}, {"label": "B", "text": "Hypermethylation of GSTP1", "correct": true}, {"label": "C", "text": "Overexpression of HER2", "correct": false}, {"label": "D", "text": "Mutation of the RB1 gene", "correct": false}], "correct_answer": "B. Hypermethylation of GSTP1", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QVdDpIvbe9c3PLP6wdEO1747241362.mp3", "video": ""}, {"text": "A 70-year-old male presents with an elevated PSA level of 12 ng/mL. A transrectal ultrasound-guided biopsy reveals a Gleason score of 9 (4 + 5). Which of the following is the most appropriate initial management approach for this patient?", "options": [{"label": "A", "text": "Active surveillance with regular PSA monitoring and repeat biopsies", "correct": false}, {"label": "B", "text": "Radical prostatectomy", "correct": false}, {"label": "C", "text": "Hormone therapy and possibly radiation", "correct": true}, {"label": "D", "text": "Observation with no immediate treatment", "correct": false}], "correct_answer": "C. Hormone therapy and possibly radiation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:545px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DRE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physical examination; detects nodules but limited in early-stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSA Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"9a70998c381692777196f5daf6edb1\">PSA</span> levels; elevated levels suggest cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TRUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging with rectal probe; detects abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>mpMRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Advanced imaging; superior for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> and capsular spread</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prostate Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold standard for diagnosis; tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> for cancer cells</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gleason</strong></p>\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n<p><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer</strong></p>\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-grade</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cells resemble healthy tissue; low likelihood of growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 + 4 or 4 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate-grade</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cells show more variation; moderate risk of growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 + 4, 3 + 5, or 5 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-grade</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cells look very different; higher likelihood of rapid growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 or 10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 + 5, 5 + 4, or 5 + 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very high-grade</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cells are highly aggressive; very likely to grow and spread quickly.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Active Surveillance </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For low-risk cases; regular monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical <span class=\"customMeta\" data-dictid=\"4f419067a61692777196c1039e5eb3\">Prostatectomy</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiation Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-energy rays; external or brachytherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone Therapy </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces/block testosterone; for advanced/metastatic cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic drug treatment; for advanced/metastatic cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2v2gl57wBwK9jdDyFjUB1747241570.mp3", "video": ""}, {"text": "A 65-year-old male patient undergoes a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. During the procedure, a tumor is discovered, which involves less than 5% of the resected tissue and is well-differentiated. The tumor was an incidental finding and was not palpable during a digital rectal examination. Based on the TNM staging system for prostate cancer, what is the most appropriate stage for this tumor?", "options": [{"label": "A", "text": "T1a", "correct": true}, {"label": "B", "text": "T1b", "correct": false}, {"label": "C", "text": "T2a", "correct": false}, {"label": "D", "text": "T3a", "correct": false}], "correct_answer": "A. T1a", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8aMJfnIAK01AVO5LotYG1747241956.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A urologist is teaching medical students about the causes of hydronephrosis. When discussing bilateral hydronephrosis, which of the following conditions is not typically associated with this presentation?", "options": [{"label": "A", "text": "Bladder neck stenosis", "correct": false}, {"label": "B", "text": "Benign prostatic hyperplasia", "correct": false}, {"label": "C", "text": "Posterior urethral valve", "correct": false}, {"label": "D", "text": "Retrocaval ureter", "correct": true}], "correct_answer": "D. Retrocaval ureter", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unilateral Hydronephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral Hydronephrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extramural Causes:</strong></p>\n<ul>\n<li>Advanced Malignancies\n\t\t\t\t<ul>\n<li>Colorectal cancer</li>\n<li>Carcinoma cervix</li>\n<li>Carcinoma Prostate</li>\n</ul>\n</li>\n<li>Retroperitoneal fibrosis</li>\n<li>Retrocaval <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">Ureter</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital Causes:</strong></p>\n<ul>\n<li>Posterior Urethral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> <strong>(Option C ruled out)</strong></li>\n<li>Urethral atresia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intramural Causes:</strong></p>\n<ul>\n<li>PUJ Obstruction</li>\n<li>Ureterocele</li>\n<li>Ureteric Stricture</li>\n<li>Urothelial tumor</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired Causes:</strong></p>\n<ul>\n<li>Bladder neck <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> <strong>(Option A ruled out)</strong></li>\n<li>BPH (Benign Prostatic Hyperplasia) <strong>(Option B ruled out)</strong></li>\n<li>CA Prostate</li>\n<li>Urethral strictures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraluminal Causes:</strong></p>\n<ul>\n<li>Stone</li>\n<li>Papillary Slough</li>\n<li>Due to:\n\t\t\t\t<ul>\n<li>Analgesic nephropathy</li>\n<li>Sickle cell anemia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iDttsmjVGNK77MWqG0IE1748351401.mp3", "video": ""}, {"text": "A male presents with a 3 cm stone in the middle calyx of the left kidney. Which of the following statements regarding the use of percutaneous nephrolithotomy (PCNL) in the management of this patient is correct?", "options": [{"label": "A", "text": "PCNL involves creating a large flank incision to directly access the renal pelvis and remove the stone", "correct": false}, {"label": "B", "text": "PCNL is indicated for the treatment of renal stones larger than 2 cm in diameter or stones resistant to ESWL", "correct": true}, {"label": "C", "text": "PCNL is performed under general anesthesia, and the patient is required to remain immobilized for several days postoperatively", "correct": false}, {"label": "D", "text": "PCNL is contraindicated in patients with severe hydronephrosis or anatomical abnormalities of the urinary tract", "correct": false}], "correct_answer": "B. PCNL is indicated for the treatment of renal stones larger than 2 cm in diameter or stones resistant to ESWL", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Hy0m5IbQn5imheJP3rTl1738945256.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uz9Zf1IqGh4Lie1NmR831748350667.mp3", "video": ""}, {"text": "In a 55-year-old male with sterile pyuria, flank pain, and a \"moth-eaten\" renal calyx appearance on CT, which test is the gold standard for confirming genitourinary tuberculosis?", "options": [{"label": "A", "text": "Retrograde Pyelogram", "correct": false}, {"label": "B", "text": "Urine Culture &amp;amp; Sensitivity", "correct": true}, {"label": "C", "text": "Intravenous Pyelogram", "correct": false}, {"label": "D", "text": "Contrast-Enhanced CT", "correct": false}], "correct_answer": "B. Urine Culture &amp; Sensitivity", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Details</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Common symptoms</td>\n<td>Flank pain, dysuria, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> pyuria, hematuria</td>\n</tr>\n<tr>\n<td>Key <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> findings</td>\n<td>Moth-eaten calyces, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> scarring, shrunken kidney</td>\n</tr>\n<tr>\n<td>Gold standard <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</td>\n<td>Urine culture for M. <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (three early-morning samples)</td>\n</tr>\n<tr>\n<td>Other helpful tests</td>\n<td>PCR for TB, CT urogram, IVP for structural changes</td>\n</tr>\n<tr>\n<td>Typical CT/IVP appearance</td>\n<td>Irregular calyces, calcification, strictures, non-functioning kidney</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yY7txqPqxBrsnqgb8Bsc1748352185.mp3", "video": ""}, {"text": "A 45-year-old man with a history of renal tuberculosis presents with increased urinary frequency and lower abdominal discomfort that has gradually worsened over the past few months. Imaging studies reveal significant fibrosis and a reduced bladder size. Which of the following features is present in the advanced stage, where the bladder is contracted?", "options": [{"label": "A", "text": "Golf hole around the ureteric orifice", "correct": true}, {"label": "B", "text": "Calcification of bladder wall", "correct": false}, {"label": "C", "text": "The beaded appearance of the distal ureter", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Golf hole around the ureteric orifice", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZzwgBWPLRB5tftourzIk1740020851.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/agQncZXxjqMLHxJ5vp0S1748352032.mp3", "video": ""}, {"text": "A 38-year-old male with a history of untreated pulmonary tuberculosis presents with symptoms of dysuria, hematuria, and flank pain, and noticed a gradual worsening of his symptoms. His laboratory tests are consistent with renal impairment. Which of the following features are seen in this condition?", "options": [{"label": "A", "text": "Caseous necrosis and tissue destruction", "correct": false}, {"label": "B", "text": "Dystrophic calcification", "correct": false}, {"label": "C", "text": "Ureteric strictures and obstruction", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": ["https://image.prepladder.com/content/DmQIzP1MLbHigoTD3cvc1740020714.png"], "explanation_images": ["https://image.prepladder.com/content/v505Pjqal5nRXK6wpRSA1740020753.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KXY437yaUy8WCT9UUPiW1748351860.mp3", "video": ""}, {"text": "A 35-year-old man presents with intermittent right flank pain and a palpable mass in his right loin. His urinalysis shows microscopic hematuria. Imaging reveals the presence of unilateral hydronephrosis. Which of the following correctly describes the condition known as Dietl's crisis?", "options": [{"label": "A", "text": "Sudden onset of flank pain accompanied by fever and pyuria", "correct": false}, {"label": "B", "text": "Intermittent flank pain with a palpable abdominal mass that resolves after voiding large volume of urine", "correct": true}, {"label": "C", "text": "Constant dull ache in the loin with progressive renal failure", "correct": false}, {"label": "D", "text": "Acute anuria associated with bilateral ureteric obstruction", "correct": false}], "correct_answer": "B. Intermittent flank pain with a palpable abdominal mass that resolves after voiding large volume of urine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unilateral Hydronephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral Hydronephrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Congenital PUJ obstruction</strong> and <strong>calculus </strong>are the most common causes</li>\n<li>Male to Female ratio 2:1</li>\n<li>Right side <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> is affected more commonly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>From lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction:</strong></p>\n<ul>\n<li>Loin pain</li>\n<li>Features of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet obstruction—frequency, hesitancy, poor stream</li>\n<li>Kidneys are not <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> if <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure develops early</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dull aching <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> pain with dragging sensation or heaviness</li>\n<li>Mass in the <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> which moves with respiration</li>\n<li><strong>Dietl's crisis (Intermittent Hydronephrosis)</strong>: <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> in the <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> after <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> colic, disappears after passing a large volume of urine<strong> (Option B)</strong></li>\n<li>Dysuria, haematuria. If infected, fever and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> angle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>From <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction:</strong></p>\n<ul>\n<li>Loin pain, mass in the loin, attacks of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> colic</li>\n<li>In severe cases, features of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure like oliguria, edema, and hiccoughs may be present</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jujphdIcB5oWWfkZFuCy1748351661.mp3", "video": ""}, {"text": "A 62-year-old diabetic man presents with fever, flank pain, and a palpable mass in his left loin. Initial ultrasound reveals a fluid collection associated with the left kidney. Which of the following statements is incorrect with respect to the probable diagnosis of this patient?", "options": [{"label": "A", "text": "Pyonephrosis is commonly seen in patients with hydronephrosis due to renal obstruction", "correct": false}, {"label": "B", "text": "Pyonephrosis can spread by cortical extension &amp;amp; hematogenous route", "correct": true}, {"label": "C", "text": "Pyonephrosis involves the collection of pus inside the kidney", "correct": false}, {"label": "D", "text": "Percutaneous nephrostomy is the treatment of choice for elderly and diabetic patients", "correct": false}], "correct_answer": "B. Pyonephrosis can spread by cortical extension &amp; hematogenous route", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyonephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perinephric Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Destruction of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> followed by <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> collection inside kidneys<strong> (Option C ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> around the kidney</li>\n<li>Spread by 2 routes: <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">Cortical</span> extension and <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">Hematogenous</span> spread <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal stones leading to <span class=\"customMeta\" data-dictid=\"441df40d111692777189b0e31acb06\">hydronephrosis</span> (the most common cause of obstruction) <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> &gt; Proteus</li>\n<li>Urine culture positive in 1/3rd of cases</li>\n<li>Blood culture positive in 50% of cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Anemia</li>\n<li>Mass in loin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Tenderness in flanks</li>\n<li>Fever</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>USG</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>USG/CT</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IV antibiotics + Drainage</li>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"d1daf6e6e71692777193b4da27724f\">nephrostomy</span> (Elderly, diabetic, etc) <strong>(Option D ruled out)</strong></li>\n<li>For Non-Functioning Kidney: Nephrectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IV antibiotics + <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> drainage</li>\n<li>If the patient does not respond after <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> drainage, then go for Open <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> / Nephrectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BPuEuuOCNfNrpKzqUpFo1748351221.mp3", "video": ""}, {"text": "A 55-year-old female with poorly controlled diabetes presents with fever, flank pain, and vomiting. Initial investigations reveal a kidney infection. Which of the following findings is likely to be seen in Emphysematous Pyelonephritis but not in Xanthogranulomatous Pyelonephritis?", "options": [{"label": "A", "text": "Presence of Proteus as the causative organism", "correct": false}, {"label": "B", "text": "Air within the kidney or perinephric region on imaging", "correct": true}, {"label": "C", "text": "Association with struvite stones", "correct": false}, {"label": "D", "text": "Foamy lipid-laden histiocytes in renal parenchyma", "correct": false}], "correct_answer": "B. Air within the kidney or perinephric region on imaging", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qsBJ91rdJjl2mHcYvnyr1740020511.png", "https://image.prepladder.com/content/C6iCIEZTVrNSbhTadN521740020567.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:745px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Emphysematous Pyelonephritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Xanthogranulomatous Pyelonephritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Presence of air around the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> or within the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Chronic bacterial infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>E. coli, Klebsiella</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Proteus <strong>(most common) </strong><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Associations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Diabetes (due to low immunity), Female gender</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"0f125a33661692777199eec6125223\">Struvite</span> stones <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Flank pain, Fever, Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Flank pain, Fever with chills and rigor, <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">Flank</span> Mass, Bacteriuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Investigation of Choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>CT scan</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>CECT <strong>(Bear’s <span class=\"customMeta\" data-dictid=\"27e3bff9a21692777194ab2ee09585\">paw</span> sign)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>The presence of air in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> and <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> of surrounding structures</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"73d908af3f1692777202739424254c\">Xanthoma</span> cells in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> (Foamy lipid-laden histiocytes) <strong>(Option D ruled out)</strong></li>\n<li>Mimics Clear cell <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> of RCC</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>IV antibiotics</li>\n<li>Resuscitation</li>\n<li>Control blood glucose</li>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> if <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> is present</li>\n<li>Nephrectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Initially, Partial Nephrectomy</li>\n<li>If not possible, total Nephrectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Walizai T, Elfeky M, Silverstone L\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/emphysematous-pyelonephritis\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/qsBJ91rdJjl2mHcYvnyr1740020511.png\" width=\"500\"/></p>\n<p>This <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">computed tomography</span> (CT) scan demonstrates extensive destruction of the right <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with intraparenchymal gas on the right, obliterating the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> architecture. The left <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> is normal.</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Xu, Zhunan &amp; Cai, Tong &amp; Zhang, Xuebao &amp; Wu, Jitao &amp; Liu, Chu. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Bear-paw-sign-multiple-rounded-low-density-areas-with-enhancing-rings-arranged-in-a_fig1_355754695\" data-tags=\"\" height=\"407\" src=\"https://image.prepladder.com/content/C6iCIEZTVrNSbhTadN521740020567.png\" width=\"500\"/></p>\n<p>Xanthogranulomatous <span class=\"customMeta\" data-dictid=\"7d244db63c1692777196490682ecc8\">pyelonephritis</span> with the ‘bear’s <span class=\"customMeta\" data-dictid=\"27e3bff9a21692777194ab2ee09585\">paw</span> sign’</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8GuOM2V60zHY9FgGMAGm1748350983.mp3", "video": ""}, {"text": "A 60-year-old patient with a history of recurrent renal stones is scheduled for laser-based intracorporeal lithotripsy to treat a 2 cm stone in the renal pelvis. Which of the following lasers is most commonly used for intracorporeal lithotripsy procedures?", "options": [{"label": "A", "text": "Carbon dioxide laser", "correct": false}, {"label": "B", "text": "Neodymium: YAG laser", "correct": false}, {"label": "C", "text": "Holmium: YAG laser", "correct": true}, {"label": "D", "text": "Helium laser", "correct": false}], "correct_answer": "C. Holmium: YAG laser", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of <span class=\"customMeta\" data-dictid=\"0bd3cf6d8c1692777190bfb72e92ce\">Intracorporeal</span> Lithotripsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laser Lithotripsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Holmium: YAG laser</li>\n<li>Used in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> stones and BPH</li>\n<li>Stone <span class=\"customMeta\" data-dictid=\"ddc660fe4f16927772016b7953d1f1\">vaporization</span> by photo-thermal mechanism</li>\n<li>Costly but safe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrohydraulic <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">Lithotripsy</span> (EHL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cheap but low safety margin</li>\n<li>Mainly used for <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> stones</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasonic Lithotripsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not commonly used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ballistic Lithotripsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not commonly used</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6kFWKarnKdtCeuJ67lXK1748350819.mp3", "video": ""}, {"text": "Which of the following is the most common type of radiolucent renal stone?", "options": [{"label": "A", "text": "Calcium Oxalate Stones", "correct": false}, {"label": "B", "text": "Uric Acid Stones", "correct": true}, {"label": "C", "text": "Cystine Stones", "correct": false}, {"label": "D", "text": "Xanthine Stones", "correct": false}], "correct_answer": "B. Uric Acid Stones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Q4rSsb5bxytHNH2O28Mh1740019431.png", "https://image.prepladder.com/content/YCY9NsvDn0W3TbSZO0lv1740019468.png", "https://image.prepladder.com/content/QJzuEFVADi8d5BDvwzH61740019502.png", "https://image.prepladder.com/content/62nsAFahS1DMyd9cJDO61740019543.png", "https://image.prepladder.com/content/TChKPj3IQ3aQi2eKw3sO1740019586.png", "https://image.prepladder.com/content/gmDXGZB0DyAdWAjoRJh21740019626.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stone Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Oxalate</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>The most common type of stone (60–85% of all stones)</strong> ;<strong> Radiopaque</strong></li>\n<li>Associated with hypercalciuria, hypercalcaemia, hyperoxaluria, hyperuricosuria, and hypocitraturia</li>\n<li><strong>Types:</strong> monohydrate (dumbbell shaped) , <span class=\"customMeta\" data-dictid=\"168c514d4016927771861c453b7a5a\">dihydrate</span> (envelope shaped)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Doruk Salancı\" data-hash=\"\" data-license=\"CC-by-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/Q4rSsb5bxytHNH2O28Mh1740019431.png\" width=\"127\"/></p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"Doruk Salancı\" data-hash=\"\" data-license=\"CC-by-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"140\" src=\"https://image.prepladder.com/content/YCY9NsvDn0W3TbSZO0lv1740019468.png\" width=\"127\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Phosphate</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pure <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stones are rare</li>\n<li>Types include <span class=\"customMeta\" data-dictid=\"4cd2f5e61a1692777181e000c76341\">apatite</span> and <span class=\"customMeta\" data-dictid=\"142bd44f0b1692777183ea2f5f9fb8\">brushite</span> stones</li>\n<li>Apatite stones are seen with infection; <span class=\"customMeta\" data-dictid=\"142bd44f0b1692777183ea2f5f9fb8\">brushite</span> stones are associated with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Mikael Häggström, Klinkhardt, Julius\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://en.m.wikipedia.org/wiki/File:Calcium_phosphate_crystal.jpg\" data-tags=\"\" height=\"141\" src=\"https://image.prepladder.com/content/QJzuEFVADi8d5BDvwzH61740019502.png\" width=\"150\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Struvite</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aka staghorn <span class=\"customMeta\" data-dictid=\"eae898f16d1692777183cc3469a664\">calculi</span> / Triple <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stone (Ca, Mg, NH4+, Phosphate)</li>\n<li><strong>Radiopaque</strong></li>\n<li><strong>Infection stones </strong>that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> due to <strong>urease-producing bacteria</strong> (e.g., <em>Proteus, Klebsiella, Serratia, Enterobacter</em>)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Joel Mills\" data-hash=\"\" data-license=\" CC BY-SA 3.0,\" data-source=\"https://commons.wikimedia.org/w/index.php?curid=1607945\" data-tags=\"\" height=\"125\" src=\"https://image.prepladder.com/content/62nsAFahS1DMyd9cJDO61740019543.png\" width=\"150\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystine</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radiopaque</strong>, Constitute approximately 1% of stones</li>\n<li>Result from <strong>cystinuria</strong>, an autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> inherited disease that causes decreased <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of cystine</li>\n<li>Very hard stones due to <span class=\"customMeta\" data-dictid=\"dee47c70a41692777186cf17523799\">disulfide</span> bonds</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Lance Wheeler\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Cystinuria#/media/File:Cystine_Crystals_in_Canine_Urine_Sediment.jpg\" data-tags=\"\" height=\"186\" src=\"https://image.prepladder.com/content/TChKPj3IQ3aQi2eKw3sO1740019586.png\" width=\"150\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uric Acid</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radiolucent </strong></li>\n<li>Promoted by hyperuricosuria, which can be caused by conditions like<strong> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"8dd789d7d1169277719303d4744837\">myeloproliferative</span> disorders</strong></li>\n<li>Precipitates in <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and remains <span class=\"customMeta\" data-dictid=\"845fedd06d16927771989597afa034\">soluble</span> in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> urine</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Iqbal Osman - Queremel Milani DA, Jialal I\" data-hash=\"\" data-license=\"CC By 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Uric_acid_crystals_in_urine_sediment.jpg\" data-tags=\"\" height=\"148\" src=\"https://image.prepladder.com/content/gmDXGZB0DyAdWAjoRJh21740019626.png\" width=\"150\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LI0SfEPZNbIL5hpYhPxr1748347270.mp3", "video": ""}, {"text": "A male underwent ESWL for a 2 cm renal stone 4 weeks ago. Imaging now reveals multiple small stone fragments (street of stone) in the ureter. Which of the following statements regarding the management of this condition is correct?", "options": [{"label": "A", "text": "Urgent ureteroscopy should be performed to remove the obstructing stone fragments", "correct": false}, {"label": "B", "text": "Conservative management with alpha-blocker therapy is the first-line approach", "correct": true}, {"label": "C", "text": "Repeat ESWL is the preferred option to further fragment the retained stone pieces", "correct": false}, {"label": "D", "text": "Percutaneous nephrolithotomy is the treatment of choice to clear the Steinstrasse", "correct": false}], "correct_answer": "B. Conservative management with alpha-blocker therapy is the first-line approach", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/I2O6pdt6L74ujLskyw0Z1740020137.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8kcMWdxJtFFY1Od8Vz6m1748350387.mp3", "video": ""}, {"text": "A male presents with a 10 mm stone in the lower pole of the left kidney. Regarding the use of extracorporeal shock wave lithotripsy (ESWL) for this patient, which of the following statements is false?", "options": [{"label": "A", "text": "ESWL works by generating focused shock waves that pass through the body and fragment the stone", "correct": false}, {"label": "B", "text": "ESWL is contraindicated in patients with significant skeletal deformities or obesity", "correct": false}, {"label": "C", "text": "ESWL can be performed on stones less than 2 cm in diameter for optimal fragmentation", "correct": true}, {"label": "D", "text": "Post-ESWL, the patient is encouraged to ambulate soon after the procedure to facilitate stone passage", "correct": false}], "correct_answer": "C. ESWL can be performed on stones less than 2 cm in diameter for optimal fragmentation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ft9SraYtfNmDu1zhx3651740020086.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/K6L3wOT9i4KUj7ZrUvXw1748350206.mp3", "video": ""}, {"text": "A male presents with a 5 mm lower-ureteric stone and no hydronephrosis. Which of the following is the most appropriate initial management strategy for this patient?", "options": [{"label": "A", "text": "Urgent ureteroscopic stone extraction", "correct": false}, {"label": "B", "text": "Extracorporeal shock wave lithotripsy", "correct": false}, {"label": "C", "text": "Percutaneous nephrostomy tube placement", "correct": false}, {"label": "D", "text": "Trial of conservative management with medical expulsive therapy", "correct": true}], "correct_answer": "D. Trial of conservative management with medical expulsive therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GJeJE93wmal80MfaErW41748349980.mp3", "video": ""}, {"text": "A 30 years old male presents with recurrent episodes of right flank pain and hematuria. Ultrasonography and plain abdominal radiography are inconclusive for renal stones. Which of the following statements regarding the use of radionuclide scans in the evaluation of this patient is correct?", "options": [{"label": "A", "text": "Technetium-99m dimercaptosuccinic acid (DMSA) scan is the preferred modality to diagnose renal stones", "correct": false}, {"label": "B", "text": "Gallium-67 citrate scan has higher sensitivity and specificity than DMSA scan for detecting renal stones", "correct": false}, {"label": "C", "text": "Radionuclide scans are exclusively reserved for patients with impaired renal function", "correct": false}, {"label": "D", "text": "Radionuclide scans can distinguish between obstructing and non-obstructing renal stones", "correct": true}], "correct_answer": "D. Radionuclide scans can distinguish between obstructing and non-obstructing renal stones", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pshKEOIPZDwOlriM4W821748349811.mp3", "video": ""}, {"text": "Which of the following investigations is considered the gold standard for diagnosing renal stones and can identify both radiopaque and radiolucent stones?", "options": [{"label": "A", "text": "Kidney, Ureter, and Bladder X-ray", "correct": false}, {"label": "B", "text": "Ultrasound", "correct": false}, {"label": "C", "text": "Non-contrast computed tomography", "correct": true}, {"label": "D", "text": "Intravenous urogram", "correct": false}], "correct_answer": "C. Non-contrast computed tomography", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/u4CtrvVaj1lCi9WJAXhy1748349634.mp3", "video": ""}, {"text": "A 35-year-old woman presents with recurrent urinary tract infections (UTIs), persistent back pain, and hematuria. Imaging reveals a large, branched stone occupying a significant portion of her right kidney. Urinalysis shows alkaline pH, the presence of bacteria, and crystals as shown below. Which of the following is the most likely composition of this stone?", "options": [{"label": "A", "text": "Calcium oxalate", "correct": false}, {"label": "B", "text": "Uric acid", "correct": false}, {"label": "C", "text": "Struvite", "correct": true}, {"label": "D", "text": "Cystine", "correct": false}], "correct_answer": "C. Struvite", "question_images": ["https://image.prepladder.com/content/cQgiSCoe2CcHKbeKfSpc1740019906.png"], "explanation_images": ["https://image.prepladder.com/content/f3WUqk4Dy0nYz6godjTI1740019730.png", "https://image.prepladder.com/content/1QRxZQazTQBLF4nrrNp91740019771.png", "https://image.prepladder.com/content/e16kD1k2gxRcJsQ7PqnQ1740019803.png", "https://image.prepladder.com/content/7xZ0lk61nXNyc91td7qk1740019836.png", "https://image.prepladder.com/content/bZe0ROJLnWB8yY0GegN01740019866.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Xo2XZWjDLytjbSD8epbd1748349531.mp3", "video": ""}, {"text": "A 42-year-old male presents to the emergency department with severe abdominal pain. Imaging reveals that he has a renal stone lodged in the middle third of his ureter. He describes the pain as radiating to his hypogastrium. Which nerve is responsible for the radiation of pain to the hypogastrium?", "options": [{"label": "A", "text": "Ilioinguinal Nerve", "correct": false}, {"label": "B", "text": "Iliohypogastric Nerve", "correct": true}, {"label": "C", "text": "Genitofemoral Nerve", "correct": false}, {"label": "D", "text": "Femoral Nerve", "correct": false}], "correct_answer": "B. Iliohypogastric Nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/j0klx7Js1MJdRdA3QPIU1748347620.mp3", "video": ""}, {"text": "A 50-year-old man with a history of HIV, on ART, presents to the emergency department with severe flank pain, hematuria, and difficulty urinating. Recent imaging studies reveal the presence of renal stones. Which of the following ART drugs is commonly associated with the development of renal stones?", "options": [{"label": "A", "text": "Indinavir", "correct": true}, {"label": "B", "text": "Efavirenz", "correct": false}, {"label": "C", "text": "Nevirapine", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Indinavir", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zb9NfzJCQsFw1qWJaPEp1748347376.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old man presents with bilateral scrotal swelling. On examination, tense clusters that feel like bunches of grapes are palpable posterior to the testis and positive transillumination seen. Which of the following is the most appropriate management option if the patient reports discomfort?", "options": [{"label": "A", "text": "Aspiration of the cysts", "correct": false}, {"label": "B", "text": "Total epididymectomy", "correct": false}, {"label": "C", "text": "Ultrasound-guided drainage", "correct": false}, {"label": "D", "text": "Excision of the cysts", "correct": true}], "correct_answer": "D. Excision of the cysts", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epididymal <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fluid-filled sacs resulting from <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of the epididymis</li>\n<li>Commonly found in middle-aged men</li>\n<li>Often bilaterally in the scrotum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Location &amp; Palpation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Positioned <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to and separate from the testis.</li>\n<li>Palpable as <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> clusters, resembling tiny bunches of grapes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transilluminate like other <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> scrotal lesions; confirmed by <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> examination.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small, <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> cysts may not require treatment.<strong>(Option D)</strong></li>\n<li>Larger, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> cysts can be surgically excised.</li>\n<li>Aspiration is ineffective due to the <span class=\"customMeta\" data-dictid=\"8b7df3d24316927771937881a04879\">multilocular</span> nature of the cysts. <strong>(Option A)</strong></li>\n<li>For <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> or <span class=\"customMeta\" data-dictid=\"8b7df3d24316927771937881a04879\">multilocular</span> cysts, partial or total <span class=\"customMeta\" data-dictid=\"d8ec064ba31692777187d45364e7b9\">epididymectomy</span> may be necessary.<strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/N9mLmJgRgtFZ9oI3GqqI1748701981.mp3", "video": ""}, {"text": "A 35-year-old man presents with a painless, firm scrotal mass. Serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) levels are elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Epididymal cyst", "correct": false}, {"label": "B", "text": "Orchitis", "correct": false}, {"label": "C", "text": "Chimney sweep cancer", "correct": true}, {"label": "D", "text": "Hydrocele", "correct": false}], "correct_answer": "C. Chimney sweep cancer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ht0oV7g3Qeyc6R0Kww2v1740028197.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aromatic <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> hydrocarbons, Coal products.Most common in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> between 15-35 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically presents as a painless, firm mass in the scrotum.</li>\n<li>May include swelling, heaviness, or discomfort, though it is often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> initially.</li>\n<li>Growth starts as ulcers with everted edges and <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> base.</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels of alpha-fetoprotein (AFP) and human <span class=\"customMeta\" data-dictid=\"6d72527c991692777184af095c6f14\">chorionic gonadotropin</span> (hCG).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of Choice </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Testicular biopsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with 2 cm margin of healthy skin.</li>\n<li>High radical Orchidectomy</li>\n<li>Chemotherapy and Radiation Therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VTFfY16TW1oGh1UtqAy01748703368.mp3", "video": ""}, {"text": "For a patient with Stage I seminoma, which of the following is the most appropriate treatment?", "options": [{"label": "A", "text": "Radical Orchidectomy followed by adjuvant chemotherapy", "correct": false}, {"label": "B", "text": "Radical Orchidectomy followed by adjuvant radiotherapy", "correct": true}, {"label": "C", "text": "High-dose chemotherapy", "correct": false}, {"label": "D", "text": "Radical Orchidectomy alone", "correct": false}], "correct_answer": "B. Radical Orchidectomy followed by adjuvant radiotherapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Seminoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Seminomatous GCT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RPLND</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemotherapy + RPLND</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III &amp; IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemotherapy + Metastasectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemotherapy + <span class=\"customMeta\" data-dictid=\"b75117df7116927771972d8194d4d2\">RPLND</span> + Metastasectomy</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:526px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STAGE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour confined to testis(T1-T2), No <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement and no distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour with regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement (N1-N3), but no distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (M0).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour with distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (M1a or M1b).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes any T, any N, with distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (M1b), or with extensive local invasion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/H0cU672NdFiFgicKpG7L1748703204.mp3", "video": ""}, {"text": "Match the tumor markers with their associated testicular tumor types: Tumor Markers Tumor Types 1. AFP (Alpha-fetoprotein) a. Seminoma 2. HCG (Human Chorionic Gonadotropin) b. Yolk Sac Tumor 3. LDH (Lactate Dehydrogenase) c. Choriocarcinoma 4. CA-125 d. Ovarian cancer", "options": [{"label": "A", "text": "1-b,2-c,3-a,4-d", "correct": true}, {"label": "B", "text": "1-d,2-b,3-c,4-a", "correct": false}, {"label": "C", "text": "1-a,2-d,3-b,4-c", "correct": false}, {"label": "D", "text": "1-c,2-a,3-d,4-b", "correct": false}], "correct_answer": "A. 1-b,2-c,3-a,4-d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of Tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AFP (Alpha-fetoprotein)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumor</li>\n<li>Embryonal carcinoma</li>\n<li>Teratoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HCG (Human Chorionic Gonadotropin)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Choriocarcinoma</li>\n<li>Embryonal carcinoma</li>\n<li>Mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">Germ</span> Cell Tumor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LDH (Lactate Dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PLAP (Placenta Like <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> Phosphatase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GGT (Gamma <span class=\"customMeta\" data-dictid=\"95d20dd126169277718806f8815a13\">Glutamyl</span> Transpeptidase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LvUs42URJMBWHhG83KJL1748703042.mp3", "video": ""}, {"text": "A 25 years old man presents with a painless testicular mass. On examination, non-tender 3 cm mass in the right testicle is found.Ultrasound reveals a homogeneous, hypoechoic intratesticular mass. Serum tumor markers show elevated beta-hCG and LDH but normal AFP. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Leydig cell tumor", "correct": false}, {"label": "B", "text": "Embryonal carcinoma", "correct": false}, {"label": "C", "text": "Seminoma", "correct": true}, {"label": "D", "text": "Teratoma", "correct": false}], "correct_answer": "C. Seminoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FolOvP7gKvgKxIfQIedT1740027906.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Feature</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Details</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seminoma, the most common pure testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumor in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> aged 25-45</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Germinal <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painless, firm <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or mass in the testicle, typically unilateral. Accounts for 50% of all testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors. 10% have secondary hydrocele, 5% have gynecomastia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AFP: Normal</p>\n<p>hCG: Normal or mildly elevated</p>\n<p>LDH: Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Homogeneous, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> mass</p>\n<p>Histology: Sheets of <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> cells with clear cytoplasm, large <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> with prominent <span class=\"customMeta\" data-dictid=\"829d67cd9816927771800b7303f9cc\">acidophilic</span> nucleoli</p>\n<img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg#mw-jump-to-license\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/FolOvP7gKvgKxIfQIedT1740027906.png\" width=\"4167\"/>\n<p>FNAC: Contraindicated due to risk of tumor cell seeding and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary: High Inguinal Radical Orchidectomy</p>\n<p>Adjuvant: Radiation therapy or <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> for positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/42AWXRTAG2M8xEfPdYZd1748702924.mp3", "video": ""}, {"text": "A 28-year-old man undergoes a radical orchiectomy for a painless,enlarging testicular mass. Histopathology reveals neoplastic cells confined to the seminiferous tubules without stromal invasion.Serum tumor markers are within normal limits.Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Seminoma", "correct": false}, {"label": "B", "text": "Yolk sac tumor", "correct": false}, {"label": "C", "text": "Leydig cell tumor", "correct": false}, {"label": "D", "text": "Intratubular germ cell neoplasm (ITGCN)", "correct": true}], "correct_answer": "D. Intratubular germ cell neoplasm (ITGCN)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1IaM2Ch1YSI57JdLzujd1740027856.png"], "explanation": "<p>Correct Answer:D) &lt;span class=\"customMeta\" data-dictid=\"f0e0dc86cd16927771909dcd73bf0e\"&gt;Intratubular&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\"&gt;germ&lt;/span&gt; cell &lt;span class=\"customMeta\" data-dictid=\"1622f69a94169277719372b76236ca\"&gt;neoplasm&lt;/span&gt; (ITGCN)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WeHAncSiqRCuTIzagOGG1748702762.mp3", "video": ""}, {"text": "Match the following WHO classification of tumors with its corresponding tumor :- 1. Germ cell tumors derived from germ cell neoplasia in situ A. Gonadoblastoma 2. Germ cell tumors unrelated to germ cell neoplasia in situ B. Prepubertal-type teratoma 3. Sex cord-stromal tumors C. Sertoli cell tumor 4.Nonseminomatous germ cell tumors D. Choriocarcinoma", "options": [{"label": "A", "text": "1 - A; 2 - B; 3 - C; 4 - D", "correct": true}, {"label": "B", "text": "1 - B; 2 - A; 3 - C; 4 - D", "correct": false}, {"label": "C", "text": "2 - B; 1 - C; 3 - D; 4 - A", "correct": false}, {"label": "D", "text": "4 - A; 3 - B; 2 - C; 1 - D", "correct": false}], "correct_answer": "A. 1 - A; 2 - B; 3 - C; 4 - D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #bfbfbf; border-left:1px solid #bfbfbf; border-right:1px solid #bfbfbf; border-top:1px solid #bfbfbf; vertical-align:top\">\n<p><strong>Germ cell tumors derived from <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> in situ</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #bfbfbf; border-left:1px solid #bfbfbf; border-right:1px solid #bfbfbf; border-top:1px solid #bfbfbf; vertical-align:top\">\n<p>Noninvasive <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell neoplasia</p>\n<ul>\n<li>GCNIS (germ cell <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> in situ)</li>\n<li>Specific forms of <span class=\"customMeta\" data-dictid=\"f0e0dc86cd16927771909dcd73bf0e\">intratubular</span> <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell neoplasia</li>\n<li>Gonadoblastoma</li>\n</ul>\n<p>The <span class=\"customMeta\" data-dictid=\"a8ca70d0ff16927771886ead37dd1a\">germinoma</span> family of tumors</p>\n<ul>\n<li>Seminoma</li>\n</ul>\n<p>Nonseminomatous <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors</p>\n<ul>\n<li>Embryonal carcinoma</li>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumor, postpubertal type</li>\n<li>Choriocarcinoma</li>\n<li>Placental site trophoblastic tumor</li>\n<li>Epithelioid trophoblastic tumor</li>\n<li>Teratoma, postpubertal type</li>\n<li>Teratoma with somatic-type malignancy</li>\n</ul>\n<p>Mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors of the testis</p>\n<ul>\n<li>Mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors</li>\n</ul>\n<p>Germ cell tumors of unknown type</p>\n<ul>\n<li>Regressed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #bfbfbf; border-left:1px solid #bfbfbf; border-right:1px solid #bfbfbf; border-top:1px solid #bfbfbf; vertical-align:top\">\n<p><strong>Germ cell tumors unrelated to <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> in situ</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #bfbfbf; border-left:1px solid #bfbfbf; border-right:1px solid #bfbfbf; border-top:1px solid #bfbfbf; vertical-align:top\">\n<ul>\n<li>Spermatocytic tumor</li>\n<li>Teratoma, prepubertal-type</li>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumor, prepubertal type</li>\n<li>Testicular <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumor, prepubertal type</li>\n<li>Mixed <span class=\"customMeta\" data-dictid=\"ee123cf86916927772004fc7b0a157\">teratoma</span> and <span class=\"customMeta\" data-dictid=\"9398e57d2b16927772027826f82b50\">yolk</span> <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumor, prepubertal type</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #bfbfbf; border-left:1px solid #bfbfbf; border-right:1px solid #bfbfbf; border-top:1px solid #bfbfbf; vertical-align:top\">\n<p><strong>Sex cord-stromal tumors of the testis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #bfbfbf; border-left:1px solid #bfbfbf; border-right:1px solid #bfbfbf; border-top:1px solid #bfbfbf; vertical-align:top\">\n<p>Leydig cell tumor</p>\n<ul>\n<li>Leydig cell tumor</li>\n</ul>\n<p>Sertoli cell tumor</p>\n<ul>\n<li>Sertoli cell tumor</li>\n<li>Large cell calcifying Sertoli cell tumor</li>\n</ul>\n<p>Granulosa cell tumor</p>\n<ul>\n<li>Adult <span class=\"customMeta\" data-dictid=\"ac2dfd97cd16927771888be9de7ded\">granulosa</span> cell tumor</li>\n<li>Juvenile <span class=\"customMeta\" data-dictid=\"ac2dfd97cd16927771888be9de7ded\">granulosa</span> cell tumor</li>\n</ul>\n<p>The <span class=\"customMeta\" data-dictid=\"984f7ab3d31692777202759795db32\">fibroma</span> <span class=\"customMeta\" data-dictid=\"b79e183f43169277720034c7ff540d\">thecoma</span> family of tumors</p>\n<ul>\n<li>Tumors in the <span class=\"customMeta\" data-dictid=\"984f7ab3d31692777202759795db32\">fibroma</span> <span class=\"customMeta\" data-dictid=\"b79e183f43169277720034c7ff540d\">thecoma</span> group</li>\n</ul>\n<p>Mixed and other sex cord-stromal tumors</p>\n<ul>\n<li>Mixed sex cord-stromal tumor</li>\n<li>Signet ring stromal tumor</li>\n<li>Myoid gonadal stromal tumor</li>\n<li>Sex cord-stromal tumor NOS (not otherwise specified)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/h2X8F8yFPI0XBLuQQcqc1748702579.mp3", "video": ""}, {"text": "A 30-year-old male presents with a painless testicular mass. On physical examination, a solid intratesticular mass is palpable, and there is difficulty in palpating the epididymis. Which of the following associated findings would most likely be present in this patient?", "options": [{"label": "A", "text": "Cough and dyspnea", "correct": false}, {"label": "B", "text": "Gynecomastia", "correct": true}, {"label": "C", "text": "Lower extremity swelling", "correct": false}, {"label": "D", "text": "Lumbar back pain", "correct": false}], "correct_answer": "B. Gynecomastia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular tumor- clinical features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial Symptom: Painless testicular lump.</li>\n<li>Heaviness: Noted with larger tumors.</li>\n<li>Pain: Uncommon, may occur due to hemorrhage, mimicking torsion.</li>\n<li>Metastatic Disease: Rarely the first symptom.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physical Examination</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Solid <span class=\"customMeta\" data-dictid=\"a9577c20d11692777190a74f98e177\">Intratesticular</span> Mass: Palpable.</li>\n<li>Secondary Hydrocele: May complicate examination.</li>\n<li>Epididymis: Difficult to <span class=\"customMeta\" data-dictid=\"5aabcb1ee8169277719447f2dd6c2c\">palpate</span> due to tumor.</li>\n<li>Gynaecomastia: Seen in ~5% of cases, mainly in non-seminomatous <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors.<strong>(Option B)</strong></li>\n<li>Bilateral Tumors: Present at diagnosis in 1-2% of cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presentation of Metastatic Disease (10%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neck Mass: <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">Supraclavicular</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</li>\n<li>Cough/Dyspnea: <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> metastasis.<strong>(Option A)</strong></li>\n<li>Gastrointestinal Symptoms: Anorexia, nausea, vomiting, or <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> from retroduodenal metastasis.</li>\n<li>Lumbar Back Pain: <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">Retroperitoneal</span> disease involving <span class=\"customMeta\" data-dictid=\"1ca45620ed1692777196a47f648338\">psoas</span> muscle or nerve roots.<strong>(Option D)</strong></li>\n<li>Bone Pain: Indicative of skeletal metastasis.</li>\n<li>Neurological Symptoms: <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> or <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> nerve involvement.</li>\n<li>Lower <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">Extremity</span> Swelling: Due to <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> or <span class=\"customMeta\" data-dictid=\"c7188521b31692777183cefe56a620\">caval</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or thrombosis.<strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> Manifestations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gynecomastia: <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">Linked</span> to hCG, mainly in <span class=\"customMeta\" data-dictid=\"209abd0cee16927771843bab0de87c\">choriocarcinoma</span> or trophoblastic cells.</li>\n<li>Paraneoplastic Hyperthyroidism: Due to hCG's thyroid-stimulating activity.</li>\n<li>Paraneoplastic <span class=\"customMeta\" data-dictid=\"fae243395d16927771917dbd1992e9\">Limbic</span> Encephalitis: Rare, associated with anti-Ma2 antibodies.</li>\n<li>Precocious Puberty: Associated with Leydig cell tumors.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/crZsKQXwOpj8XXoAwZKx1748702336.mp3", "video": ""}, {"text": "A 28-year-old man presents for a routine physical exam. He has a history of cryptorchidism corrected by orchidopexy in childhood. What is his relative risk of developing testicular cancer compared to the general population?", "options": [{"label": "A", "text": "No increased risk", "correct": false}, {"label": "B", "text": "1.5 to 3.5 times higher", "correct": false}, {"label": "C", "text": "2 times higher", "correct": false}, {"label": "D", "text": "3.7 to 7.5 times higher", "correct": true}], "correct_answer": "D. 3.7 to 7.5 times higher", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular tumor- risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Major Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptorchidism: Most significant risk factor, increasing risk by 3.7 to 7.5 times, even after <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> (orchidopexy). <strong>(Option D)</strong></li>\n<li>Family History: 3.1-fold increased risk for first-degree relatives, 6.3-fold for brothers.</li>\n<li>Male Factor Infertility: Includes conditions like Klinefelter syndrome.</li>\n<li>Personal History: Previous <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> tumor or <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (GCNIS).</li>\n<li>Maternal and <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">Perinatal</span> Factors: Low birth weight, <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> inguinal hernia, <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age at conception, and exposure to <span class=\"customMeta\" data-dictid=\"05784774fc1692777186a454f6f3d9\">diethylstilbestrol</span> (DES) during pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age: Most common in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> aged 20–35; smaller peak after age 80.</li>\n<li>Ethnicity: Highest <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in Caucasian men, followed by Hispanics, Asians, and African-Americans..</li>\n<li>Age at Puberty: Early <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> may increase risk; late <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> may be protective.</li>\n<li>Genetic Conditions: Increased risk associated with <span class=\"customMeta\" data-dictid=\"8e151ee847169277719083d35bdd10\">Klinefelter syndrome</span> and Down syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ogBeF2xnNdBOY1k2APbR1748702206.mp3", "video": ""}, {"text": "A 60-year-old male with a history of diabetes presents with intense pain, swelling, and erythema of the scrotum. Physical examination reveals dusky skin and subcutaneous crepitation. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Oral antibiotics", "correct": false}, {"label": "B", "text": "Immediate surgical debridement", "correct": true}, {"label": "C", "text": "Observation and pain management", "correct": false}, {"label": "D", "text": "Aspiration of the affected area", "correct": false}], "correct_answer": "B. Immediate surgical debridement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Necrotizing infection of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li>Prodromal Phase: Fever and lethargy.</li>\n<li>Early Pain Phase: Intense pain, possible edema, pruritus.</li>\n<li>Progressive Phase: Increased pain, erythema.</li>\n<li>Crepitation Phase: Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li>Gangrene Phase: <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial Treatment:</li>\n</ul>\n<p>1. Fluid resuscitation.</p>\n<p>2. <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">Broad-spectrum</span> antibiotics.</p>\n<p>3. <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> debridement of necrotic tissue.</p>\n<ul>\n<li>Additional Measures:</li>\n</ul>\n<p>1. <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> and fecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</p>\n<p>2. <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">Intensive</span> monitoring for sepsis.</p>\n<p>3. Wound review and vacuum-assisted dressing.</p>\n<p>4. Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/m2jFo2Rv0nD1qY2CJRUO1748702091.mp3", "video": ""}, {"text": "Which of the following factors are responsible for testicular descent? Testosterone Gubernaculum Intra-abdominal Pressure CGRP (Calcitonin Gene-Related Peptide) INSL3 (Insulin-like 3) Processus Vaginalis", "options": [{"label": "A", "text": "1, 2, and 3", "correct": false}, {"label": "B", "text": "1, 2, and 6", "correct": false}, {"label": "C", "text": "1, 3, 4, and 6", "correct": false}, {"label": "D", "text": "1,2,3,4,5,6", "correct": true}], "correct_answer": "D. 1,2,3,4,5,6", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VdYKvdkNw9IhyKmmyOBB1740027697.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role in Testicular Descent</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testosterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"5e029d433616927771888e1bdf4520\">gubernaculum</span> shortening, guiding the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> into the scrotum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gubernaculum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> that pulls the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> down during descent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intra-abdominal Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps push the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> through the inguinal canal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CGRP (Calcitonin Gene-Related Peptide)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supports <span class=\"customMeta\" data-dictid=\"5e029d433616927771888e1bdf4520\">gubernaculum</span> development during the early <span class=\"customMeta\" data-dictid=\"bedf1c51321692777200696ea6dc51\">transabdominal</span> phase.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INSL3 (Insulin-like 3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"5e029d433616927771888e1bdf4520\">gubernaculum</span> elongation, aiding descent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Processus Vaginalis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides the <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> through which the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> descend.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous Drainage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular Artery:</strong> From the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> aorta.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pampiniform Plexus:</strong> Drains into the testicular veins.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cremasteric Artery:</strong> From the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric artery, supplies the <span class=\"customMeta\" data-dictid=\"e082e05dc416927771853d8fbe8044\">cremaster</span> muscle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right Testicular Vein:</strong> Drains into the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Artery of the <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">Vas</span> Deferens:</strong> From the superior <span class=\"customMeta\" data-dictid=\"5dad1358d7169277720161bd00a450\">vesical</span> artery, also contributes to testicular blood supply.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left Testicular Vein:</strong> Drains into the left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Gb4kh5SnI6iuSzvG4aEH1748700548.mp3", "video": ""}, {"text": "A 35-year-old man presented with a swelling of the scrotum, which was diagnosed as a spermatocele. Which of the following features of the swelling would have led to this diagnosis?", "options": [{"label": "A", "text": "Location of the swelling at the head of the epididymis, above and behind the body of the testis", "correct": false}, {"label": "B", "text": "Soft, cystic, and transilluminant", "correct": false}, {"label": "C", "text": "Barley water-like fluid with spermatozoa on aspiration cytology", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A unilocular, <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> derived from <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of epididymis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head of the epididymis, above and behind the body of the testis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid Content</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Barley water-like</li>\n<li>Includes spermatozoa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characteristics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Soft, cystic, and transilluminant</li>\n<li>Perceived by the patient as an additional testis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirmed through <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> cytology</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can be left alone if asymptomatic</li>\n<li>Excision is performed if the <span class=\"customMeta\" data-dictid=\"9b92b36dee1692777199c7e79f1caf\">spermatocele</span> is large or symptomatic</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9vi1lRfo8fJo0LklQfBt1748701839.mp3", "video": ""}, {"text": "A 25-year-old tall, thin male presents with a dull, aching pain in his left groin and scrotum, describing a \"bag of worms\" sensation on palpation. He was suggested to undergo Palomo's Operation. Which of the following describes the procedure?", "options": [{"label": "A", "text": "Suprainguinal extraperitoneal ligation of the testicular vein", "correct": true}, {"label": "B", "text": "Extraperitoneal excision of testicular vein", "correct": false}, {"label": "C", "text": "Excision of pampiniform plexus", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Suprainguinal extraperitoneal ligation of the testicular vein", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Si5Dpd3ac62y6f0T2eIU1740027793.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common Occurrence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in tall, thin young men</li>\n<li>More frequent on the left side, but can be bilateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic</li>\n<li>Absence or <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of the left testicular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</li>\n<li>Perpendicular entry of the left testicular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> into the left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</li>\n<li>Left-sided <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> causing <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of the left testicular vein</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effects</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased temperature in the scrotum, depressing <span class=\"customMeta\" data-dictid=\"a3b0e644a6169277719912525dffae\">spermatogenesis</span> and causing infertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling at the root of the scrotum</li>\n<li>Dragging pain in the <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> and scrotum</li>\n<li>\"Bag of worms\" feeling</li>\n<li>Impulse on coughing</li>\n<li>Swelling reduces on lying down (except in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Investigations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> of the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> and groin</li>\n<li>Ultrasound of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to check for <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumors</li>\n<li>Semen analysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment Options</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palomo's Operation: <span class=\"customMeta\" data-dictid=\"f8c909c45c16927771998f20372bcb\">Suprainguinal</span> <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> of the testicular vein</li>\n<li>Ligation of veins</li>\n<li>Excision of veins</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vGskr6DAF2QlmLJUY2p81748701736.mp3", "video": ""}, {"text": "Which of the following statements on hydrocele is false?", "options": [{"label": "A", "text": "Fluid is collected between the two layers of the tunica vaginalis", "correct": false}, {"label": "B", "text": "Primary vaginal hydrocele is common in middle-aged men", "correct": false}, {"label": "C", "text": "Lord's plication is done for large hydrocele n", "correct": true}, {"label": "D", "text": "Congenital hydrocele is reduced on lying down", "correct": false}], "correct_answer": "C. Lord's plication is done for large hydrocele n", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aetiology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defective <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of fluid by <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis due to endothelial wall damage by <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> infection</li>\n<li>Excessive production of fluid (secondary hydrocele)</li>\n<li>Interference with <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of fluid by <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels of the cord</li>\n<li>Communication with the peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in middle-aged men, prevalent in tropical countries</li>\n<li>Testis is usually large and non-palpable</li>\n<li>Fluctuant</li>\n<li>Can get above the swelling</li>\n<li>Initially transilluminant, but becomes non-transilluminant if long-standing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infantile Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tunica and <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis distended up to the internal ring</li>\n<li>No connection with the peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Processus vaginalis communicates with the peritoneal cavity</li>\n<li>Fluid disappears when lying down and recollects when standing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encysted <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">Hydrocele</span> of the Cord</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fluid collection in a portion of the patent <span class=\"customMeta\" data-dictid=\"5f2b559f9d1692777203a2e3ac1ba6\">funicular process</span> of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</li>\n<li>Fluctuant and transilluminant</li>\n<li>Located in the inguinal/inguinoscrotal/scrotal part</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Causes: Infection (filariasis, tuberculosis), injury (trauma, post herniorrhaphy), tumor (malignancy)</li>\n<li>Usually small, lax, and <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> except in cases of <span class=\"customMeta\" data-dictid=\"bcab368ebc169277720239f1f3dfb9\">filariasis</span> where it can be very large</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical Procedure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lord's <span class=\"customMeta\" data-dictid=\"8d378280de169277719566b2898510\">plication</span> - small, thin <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">hydrocele</span> with clear fluid</li>\n<li>Jaboulay's operation - partial <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> removal and eversion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FIRy6deSfX3bcynRb64W1748701530.mp3", "video": ""}, {"text": "A 15-year-old boy presented with a sudden onset of pain in the scrotum, groin, and lower abdomen. On examination of the scrotum, he is showing Deming’s sign. What is Deming’s sign?", "options": [{"label": "A", "text": "The affected testis is positioned high", "correct": true}, {"label": "B", "text": "The affected testis lies horizontally", "correct": false}, {"label": "C", "text": "Opposite testis is placed horizontally", "correct": false}, {"label": "D", "text": "The affected testis is positioned low", "correct": false}], "correct_answer": "A. The affected testis is positioned high", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direction of Rotation</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Right Testis: Rotates clockwise</li>\n<li>Left Testis: Rotates counterclockwise</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predisposing Factors</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inversion of the Testis</li>\n<li>High Investment of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">Tunica</span> Vaginalis</li>\n<li>Gap Between <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> and Epididymis</li>\n<li>Heavy Straining</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Features</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age Group: Common in children and adolescents</li>\n<li>Symptoms: Sudden onset of pain in the scrotum, groin, and lower abdomen; <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> due to pylorospasm</li>\n<li>Signs: Tenderness, redness, and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the scrotal skin</li>\n<li>Deming's Sign: Affected <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is positioned high due to twisting and <span class=\"customMeta\" data-dictid=\"e082e05dc416927771853d8fbe8044\">cremaster</span> muscle spasm</li>\n<li>Angell's Sign: Opposite <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> lies horizontally due to the presence of mesorchium</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Investigations</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>WBC Count: Elevated levels</li>\n<li>Doppler Study: To assess testicular <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pulsation</li>\n<li>Ultrasound Abdomen</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Emergency Exploration: <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">Scrotum</span> exploration and untwisting of the testis. The <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> of the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is checked.</li>\n<li>Fixation: If viable, the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is fixed to the scrotal <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> with 2-3 <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> nonabsorbable sutures (Prolene).</li>\n<li>Timing: If surgery occurs within 12-24 hours, <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> may be retained. Any delay can lead to gangrene, requiring orchidectomy.</li>\n<li>Orchidectomy Consideration: If in doubt, the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> can be retained temporarily, with <span class=\"customMeta\" data-dictid=\"97af60ca4a16927771940d71c8f0fc\">orchidectomy</span> postponed to assess viability.</li>\n<li>Postoperative Care: A repeat <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> study confirms viability. The opposite <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> should also be fixed to prevent torsion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6vhmp8cDliomox2lxxAV1746105877.mp3", "video": ""}, {"text": "A 27-year-old male is presented with a swollen, red, and painful epididymis. On examination, his vas deferens has a beaded texture and epididymis is craggy. A diagnosis of epididymo-orchitis was made. What is the most likely causative organism?", "options": [{"label": "A", "text": "Mumps", "correct": false}, {"label": "B", "text": "Filaria", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": true}, {"label": "D", "text": "Gonococci", "correct": false}], "correct_answer": "C. Tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Viral infections like mumps</li>\n<li>Bacterial</li>\n<li>Filarial</li>\n<li>Tuberculosis</li>\n<li>Gonococcal infections</li>\n<li>Schistosomiasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Epididymis - pain, tenderness, swelling, thickening</li>\n<li>Hydrocele</li>\n<li>Tuberculosis: <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">Beaded</span> <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">vas</span> <span class=\"customMeta\" data-dictid=\"c8e17879f71692777185360caf5372\">deferens</span> with a craggy epididymis</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General: Use of analgesics and antibiotics.</li>\n<li>Specific Treatment: Diethylcarbamazine <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> (DEC) 100 mg for 3 weeks.</li>\n<li>Evaluation: Specific causes should be ruled out.</li>\n<li>Psychological Care: Long-term <span class=\"customMeta\" data-dictid=\"5e417ebfa91692777187ac1215c704\">epididymitis</span> can cause psychological disturbance; reassurance is necessary.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/E34aPtvMyBrsps5FM3Ev1748701410.mp3", "video": ""}, {"text": "A 4-year-old boy has a right testis that intermittently moves between the scrotum and the groin, especially during physical activity. The testis is retractable but can be brought down into the scrotum upon gentle manipulation, while the left testis is normally positioned. What is the most likely physiological explanation for this intermittent movement of the testis?", "options": [{"label": "A", "text": "Patent processus vaginalis", "correct": false}, {"label": "B", "text": "Undescended testis", "correct": false}, {"label": "C", "text": "Overactive dartos muscle", "correct": false}, {"label": "D", "text": "Increased tone of the cremasteric muscle", "correct": true}], "correct_answer": "D. Increased tone of the cremasteric muscle", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JnKPPuOgribiejdfNPMb1748701289.mp3", "video": ""}, {"text": "A 2 year old boy underwent surgery for an ectopic testis, followed by an orchidopexy. Several weeks later, he presents with symptoms including swelling and pain in the scrotum, along with fever. On examination, the scrotum is tender, and the affected testis appears to be positioned higher than normal. What is the most likely cause for these symptoms?", "options": [{"label": "A", "text": "Abscess formation", "correct": false}, {"label": "B", "text": "Scrotal hematoma", "correct": false}, {"label": "C", "text": "Testicular atrophy", "correct": false}, {"label": "D", "text": "Testicular torsion", "correct": true}], "correct_answer": "D. Testicular torsion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postoperative infection at the <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> site or scrotum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding or <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular Atrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shrinkage or loss of testicular function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular Necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Death of testicular tissue due to inadequate blood supply.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrent Undescended Testicle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Testicle reascends, possibly requiring reoperation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scrotal Swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postoperative scrotal <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">hydrocele</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infertility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, due to damage affecting fertility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular Torsion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of the testicle, risking blood supply.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Injury to Adjacent Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potential damage to <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">vas</span> <span class=\"customMeta\" data-dictid=\"c8e17879f71692777185360caf5372\">deferens</span> or blood vessels.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Spv0HF10V5SjVgUELTuL1748701161.mp3", "video": ""}, {"text": "An 8 months old infant is undergoing surgical exploration for an undescended testis. The surgeon follows the standard approach and examines the inguinal canal but does not find the testis in the usual tract. Which location should the surgeon check next?", "options": [{"label": "A", "text": "Superficial inguinal pouch", "correct": true}, {"label": "B", "text": "Perineum", "correct": false}, {"label": "C", "text": "Femoral canal", "correct": false}, {"label": "D", "text": "Retroperitoneum", "correct": false}], "correct_answer": "A. Superficial inguinal pouch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hL6r9wtoHY7d8CMrpHzw1740027748.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2HwRtHV54Vzsh1X3Mvcc1748700952.mp3", "video": ""}, {"text": "All are true regarding undescended testis, except?", "options": [{"label": "A", "text": "Seminoma is the most common tumor associated with undescended testis", "correct": false}, {"label": "B", "text": "Elevated abdominal temperature impairs sperm production", "correct": false}, {"label": "C", "text": "Orchidopexy is typically performed between 6-12 months of age.", "correct": false}, {"label": "D", "text": "Undescended testis causes loss of secondary sexual characteristics due to Leydig cell impairment.", "correct": true}], "correct_answer": "D. Undescended testis causes loss of secondary sexual characteristics due to Leydig cell impairment.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cryptorchidism is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inguinal/Palpable undescended testis: 80%</li>\n<li>Abdominal/Non-Palpable undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes and Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Developmental and Genetic Factors:</strong> Conditions like <span class=\"customMeta\" data-dictid=\"8e151ee847169277719083d35bdd10\">Klinefelter syndrome</span> and <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> imbalances can impair testicular descent.</li>\n<li><strong>Prematurity and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">Maternal</span> Factors:</strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> birth and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> issues like diabetes or medication exposure can lead to undescended testes.</li>\n<li><strong>Mechanical and Physical Factors: </strong>Obstructions in the inguinal canal, scrotum, or related conditions such as inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> can prevent normal testicular descent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(SATHI Mnemonic):</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>S: <span class=\"customMeta\" data-dictid=\"61755425bd1692777199771cd3fa1e\">Sterility</span> -</strong> Elevated <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> temperature can impair <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> production, leading to potential <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> if untreated.<strong>(Option B)</strong></li>\n<li><strong>A: <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> -</strong> Prolonged exposure to heat can cause the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> to shrink or become non-functional.</li>\n<li><strong>T: Trauma, Tumor, <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> </strong>- Increased risk of testicular torsion, which can cause severe pain and potentially result in testicular loss. The most common tumor associated is seminoma<strong> </strong><strong>(Option A)</strong> with the highest risk of tumor development in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> testes.</li>\n<li><strong>H: <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> - </strong>Over 90% of cases are associated with a patent <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis, increasing the risk of inguinal hernia.</li>\n<li><strong>I: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> - </strong>The undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Note: </strong>Leydig cells are unaffected, maintaining secondary sexual characteristics, while Sertoli cells are impaired, affecting spermatogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration.</li>\n<li><strong>Non-Palpable undescended testis:</strong> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> laparoscopy.</li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be utilized to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"5913e35df9169277719717f79fbae7\">Repositioning</span> (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old. <strong>(Option C)</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vNENOmapSM5z5Azmgmcp1748700764.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 28-year-old male was involved in a high-speed road traffic accident. He reports severe pelvic pain and difficulty in passing urine. On examination, there is blood at the urethral meatus, and the patient complains of suprapubic tenderness. The bladder appears to be distended, and there is a high-riding prostate on a digital rectal examination. Which of the following investigations is the most appropriate to confirm the suspected injury of this patient?", "options": [{"label": "A", "text": "Retrograde Urethrography (RGU)", "correct": true}, {"label": "B", "text": "Cystoscopy", "correct": false}, {"label": "C", "text": "Voiding Cystourethrography", "correct": false}, {"label": "D", "text": "Intravenous Pyelography (IVP)", "correct": false}], "correct_answer": "A. Retrograde Urethrography (RGU)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HERhqGRVSL01Av0kAyeR1739961388.png", "https://image.prepladder.com/content/zOkVz1YhfmnEn5qVsDmB1739961405.png", "https://image.prepladder.com/content/dyzKeZzwajrUCyiZ16ap1739961415.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/zOkVz1YhfmnEn5qVsDmB1739961405.png\" width=\"4168\"/></p>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/dyzKeZzwajrUCyiZ16ap1739961415.png\" width=\"4168\"/></p>\n<br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pelvic fractures (often due to motor vehicle accidents)</li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising (butterfly-shaped hematoma)</li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood at the meatus</li>\n<li>Inability to void</li>\n<li>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: Gold standard, shows the extent and location of injury</li>\n<li>Voiding <span class=\"customMeta\" data-dictid=\"c65af338d916927771853b83a9c9c5\">Cystourethrography</span> (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair <strong>(Option C)</strong></li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU) (Option A): Gold standard</strong> for initial assessment</li>\n<li>CT Urethrography: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Cystoscopy: Sometimes performed for further evaluation <strong>(Option B)</strong></li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- Pie in sky appearance <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UCKyNHe9F9zp1qGEhIhS1748694044.mp3", "video": ""}, {"text": "Which of the following statements are true regarding urethral carcinoma?", "options": [{"label": "A", "text": "Bloody discharge present", "correct": false}, {"label": "B", "text": "Prostatic urethral tumor is treated with laser ablation", "correct": false}, {"label": "C", "text": "Squamous carcinoma has a poor prognosis", "correct": false}, {"label": "D", "text": "All are true", "correct": true}], "correct_answer": "D. All are true", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bloody urethral <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> without infection</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prostatic <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> tumor</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Usually associated with <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> transitional cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> of the bladder</li>\n<li>Treatment- local laser ablation</li>\n<li>Tendency for distant spread</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Squamous Carcinoma</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Can develop in areas of <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"cb4dfcbab11692777192d282b3be7a\">metaplasia</span> in patients with <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> sclerosus (LS)</li>\n<li>Treatment- radical surgery</li>\n<li>Poor prognosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vWhzIbsCcmvdU6fZWHTj1748697243.mp3", "video": ""}, {"text": "A 45-year-old male presents with a carcinoma penis. After discussing treatment options, he is informed that his management plan may include partial penectomy. What is the nature of his cancer?", "options": [{"label": "A", "text": "Localized tumor of glans", "correct": false}, {"label": "B", "text": "Proximal penile tumor", "correct": false}, {"label": "C", "text": "T1 stage", "correct": false}, {"label": "D", "text": "T2 stage", "correct": true}], "correct_answer": "D. T2 stage", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Stage</strong></th>\n<th><strong>Description</strong></th>\n<th><strong>Typical Treatment</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Tis</strong></td>\n<td>Carcinoma in situ</td>\n<td>Topical therapy or laser excision</td>\n</tr>\n<tr>\n<td><strong>T1</strong></td>\n<td>Invades <span class=\"customMeta\" data-dictid=\"94aff4fd141692777199a78b5ed2eb\">subepithelial</span> <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</td>\n<td>Local excision, Mohs, radiation</td>\n</tr>\n<tr>\n<td><strong>T2</strong></td>\n<td>Invades <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> spongiosum or cavernosum</td>\n<td><strong>Partial penectomy</strong>, possibly LN eval</td>\n</tr>\n<tr>\n<td><strong>T3</strong></td>\n<td>Invades <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> or prostate</td>\n<td>Partial or total penectomy</td>\n</tr>\n<tr>\n<td><strong>T4</strong></td>\n<td>Invades other adjacent structures</td>\n<td>Total penectomy, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> therapy</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LOwttHjRICcrFgZQCsxF1748696831.mp3", "video": ""}, {"text": "A 45-year-old male presents with a noninvasive, localized squamous cell carcinoma on the glans penis. The lesion is well-demarcated and has not invaded deeper tissues. What is the TNM stage of his cancer?", "options": [{"label": "A", "text": "T1", "correct": false}, {"label": "B", "text": "T2", "correct": false}, {"label": "C", "text": "T3", "correct": false}, {"label": "D", "text": "Ta", "correct": true}], "correct_answer": "D. Ta", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Stage </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>TX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Primary tumors cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No evidence of a primary tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (Penile <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> neoplasia, PeIN)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Noninvasive <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria, dermis, or <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue with/without lymphovascular or <span class=\"customMeta\" data-dictid=\"849a50eb4a1692777195de19bee5ed\">perineural</span> invasion <strong>(Option A)</strong></p>\n<ul>\n<li>T1a: without invasion/high grade</li>\n<li>T1b: with invasion/high grade</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> spongiosum with or without urethral invasion <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"8c62bbe6721692777185d6892c1f31\">corpora</span> cavernosa with or without urethral invasion <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Tumor invades adjacent structures (e.g., prostate, scrotum, <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cNX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Regional nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cN0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> or visible enlarged inguinal nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cN1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Palpable mobile <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cN2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Palpable mobile <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> ≥2 inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cN3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Palpable fixed inguinal nodal mass or <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> (unilateral or bilateral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cM0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No distant metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>cM1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Distant metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>pM1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> microscopically confirmed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rpgcj4I3n9lofw0kWRGP1748695510.mp3", "video": ""}, {"text": "A 52-year-old male presents with a large, dry, verrucae-like growth on the penis. Biopsy confirms it as a Buschke-Lowenstein tumor. Which of the following is the wrong statement regarding the disease?", "options": [{"label": "A", "text": "Caused by HPV", "correct": false}, {"label": "B", "text": "Radiotherapy is contraindicated", "correct": false}, {"label": "C", "text": "Can spread through blood", "correct": true}, {"label": "D", "text": "It is curable", "correct": false}], "correct_answer": "C. Can spread through blood", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KOV52shoDZrooMQNQQER1739962467.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KALOfyPytqtEz5ZATfWj1748695321.mp3", "video": ""}, {"text": "Bowen’s disease, erythroplasia of Queyrat, and bowenoid papulosis are examples of:", "options": [{"label": "A", "text": "Premalignant penile lesions", "correct": true}, {"label": "B", "text": "Benign tumors of the penise", "correct": false}, {"label": "C", "text": "Penile malignancies", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Premalignant penile lesions", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HPV-related lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-HPV-related lesions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Bowen’s disease (BD)</p>\n<p>2. Erythroplasia of Queyrat (EQ)</p>\n<p>3. Bowenoid <span class=\"customMeta\" data-dictid=\"72f28340941692777194eb96906177\">papulosis</span> (BP)</p>\n<p>4. Giant <span class=\"customMeta\" data-dictid=\"7ab4ca4b6116927771849356a0f8d2\">condylomata</span> acuminata (GCA) or Buschke–Lowenstein tumours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Genital <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> sclerosus et atrophicus (LS)</p>\n<p>2. Penile <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> horn</p>\n<p>3. Leukoplakia</p>\n<p>4. Pseudoepitheliomatous, <span class=\"customMeta\" data-dictid=\"3ba63e956316927771904abfc4510d\">keratotic</span> <span class=\"customMeta\" data-dictid=\"fb79bcaaee16927771924015d4f3c7\">micaceous</span> <span class=\"customMeta\" data-dictid=\"67c78611fc1692777182807da0ac67\">balanitis</span> (PKMB)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bCdvsnAAuyok1KzJm2kL1748695105.mp3", "video": ""}, {"text": "Which of the following statements are correct regarding Peyronie’s Disease? Is characterized by fibrous plaques in the tunica albuginea of the penis. The plaques are typically found on the ventral aspect of the penis. Can be associated with Dupuytren’s contracture. Oral medications like pentoxifylline and vitamin E are used in medical management. The primary treatment involves immediate surgical intervention (Nesbit Operation).", "options": [{"label": "A", "text": "1, 2, and 4 are correct", "correct": false}, {"label": "B", "text": "2, 3, and 5 are correct", "correct": false}, {"label": "C", "text": "1, 3, and 4 are correct", "correct": true}, {"label": "D", "text": "2, 4, and 5 are correct", "correct": false}], "correct_answer": "C. 1, 3, and 4 are correct", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kJDVPHLsOW19ry9WwSRD1739962376.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> plaques in the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> <span class=\"customMeta\" data-dictid=\"31f0ff95651692777181fcca56acfe\">albuginea</span> of the penis, causing <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> during erections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plaque Location: </strong>Typically on the <span class=\"customMeta\" data-dictid=\"4c94b3faab16927771861e13308510\">dorsolateral</span> aspect of the penis.</p>\n<p><strong>Curvature:</strong> Resulting from <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> contraction.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Charles Turner\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Peyronies_disease.jpg\" data-tags=\"\" height=\"710\" src=\"https://image.prepladder.com/content/kJDVPHLsOW19ry9WwSRD1739962376.png\" width=\"1164\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trauma/Injury: Repeated minor trauma to the penis.</li>\n<li>Genetic Factors: Possible genetic predisposition.</li>\n<li>Connective Tissue Disorders: Associated with conditions like Dupuytren’s contracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Galezia’s Triad:</strong></p>\n<ul>\n<li><strong>Dupuytren’s Contracture:</strong> Thickening and shortening of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue in fingers.</li>\n<li><strong>Retroperitoneal Fibrosis:</strong> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">Fibrosis</span> in the <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> space.</li>\n<li><strong>Peyronie’s Disease</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painful Erection</li>\n<li>Erectile Dysfunction</li>\n<li>Penile Curvature</li>\n<li>Palpable Plaques</li>\n<li>Impotence &amp; <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">Infertility</span> (in severe cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Observation:</strong></p>\n<ul>\n<li>Spontaneous Resolution: Often improves without treatment.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Medical Management:</strong></p>\n<ul>\n<li>Oral Medications: Pentoxifylline, colchicine, <span class=\"customMeta\" data-dictid=\"daa59e9e051692777202a55a312567\">vitamin E</span> (efficacy varies).</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Surgical Intervention </strong>(If <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> Resolution Does Not Occur):</p>\n<ul>\n<li><strong>Nesbit Operation:</strong> Placement of a non-absorbable <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> opposite the <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> to correct the curvature.</li>\n<li>Plication Surgery: Shortens the longer side of the penis.</li>\n<li>Plaque <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> and Grafting: Removes <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> and replaces it with <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> material.</li>\n<li>Penile Prosthesis: For severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uqFuxR0BMXVTy4vNRHML1748694742.mp3", "video": ""}, {"text": "A 45-year-old man presents with symptoms of urinary obstruction, including difficulty in starting urination, weak urinary stream, and frequent urinary tract infections. On physical examination, he has a history of trauma to the pelvic region. A retrograde urethrogram (RGU) reveals a stricture in the anterior urethra measuring more than 2 cm. Which of the following is the most appropriate management option for this patient?", "options": [{"label": "A", "text": "Urethral Dilatation", "correct": false}, {"label": "B", "text": "Optical Internal Urethrotomy", "correct": false}, {"label": "C", "text": "Excision and reconstruction with buccal mucosa", "correct": true}, {"label": "D", "text": "Urethral Stenting", "correct": false}], "correct_answer": "C. Excision and reconstruction with buccal mucosa", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YwFNxKEmQjppssSQbrr61747223955.png", "https://image.prepladder.com/notes/FmOoKuTSElaN6E91PR0D1747224001.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal narrowing of the urethra, causing partial or complete <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> flow, leading to discomfort and severe complications if untreated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trauma (Most common): </strong>Pelvic fractures, falls, accidents, or <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> trauma from prolonged catheterization.</p>\n<p><strong>Infections: </strong>STIs like <span class=\"customMeta\" data-dictid=\"d52b47f9c716927771885108f0f859\">gonorrhea</span> and <span class=\"customMeta\" data-dictid=\"21e09b6e771692777184f66df5bf7a\">chlamydia</span> causing urethritis.</p>\n<p><strong>Medical Procedures</strong>: Urethral surgeries or radiation for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cancers.</p>\n<p><strong>Inflammatory Conditions:</strong> Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> from conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> sclerosus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Urethral Stricture:</strong> Micturating Cystourethrogram (MCU) to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> during voiding.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PSU099 Posterior Urethral Stricture RGU and MCU\" data-author=\"Pal, Partha &amp; Ray, Sayantan &amp; Talukdar, Arunansu &amp; Sonthalia, Nikhil &amp; Chakraborty, Sumit.\" data-hash=\"12715\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-Retrograde-urethrogram-demonstrating-a-narrowing-in-the-proximal-bulbar-urethra-B_fig2_262531126\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/YwFNxKEmQjppssSQbrr61747223955.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Anterior Urethral Stricture:</strong> Retrograde Urethrogram (RGU).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PSU100 Anterior Urethral stricture Labelled\" data-author=\"NA\" data-hash=\"12716\" data-license=\"NA\" data-source=\"https://www.keshavamhospital.com/stricture-urethra.php\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/FmOoKuTSElaN6E91PR0D1747224001.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n<p><strong>Emergency Evaluation: </strong>Both RGU and MCU may be used in trauma cases or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urethral Dilation:</strong> Temporary relief with dilators, often leading to recurrence. <strong>(Option A)</strong></p>\n<p><strong>Optical Internal Urethrotomy (OIU):</strong> Endoscopic <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> at the 12 o'clock position; effective for short <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> strictures (&lt;2 cm).<strong>(Option B)</strong></p>\n<p><strong>Urethroplasty:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and reconstruction; the gold standard for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> or complex strictures <strong>(Option C)</strong>.</p>\n<ul>\n<li><strong>Strictures up to 2 cm:</strong> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> with end-to-end anastomosis.</li>\n<li><strong>Strictures &gt;2 cm:</strong> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> and <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> with <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> mucosa, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> mucosa, or penile skin.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Azfuu87ClsUHLGORMzjG1748694559.mp3", "video": ""}, {"text": "Assertion: Eggplant deformity is a clinical manifestation observed in penile fracture cases. Reason: It is caused by a tear in the corpus spongiosum layer of the penis.", "options": [{"label": "A", "text": "Both Assertion and Reason are correct, and the Reason is the correct explanation for the Assertion", "correct": false}, {"label": "B", "text": "Both Assertion and Reason are correct, but the Reason is not the correct explanation for the Assertion", "correct": false}, {"label": "C", "text": "The Assertion is correct, but the Reason is incorrect", "correct": true}, {"label": "D", "text": "The Assertion is incorrect, but the Reason is correct", "correct": false}], "correct_answer": "C. The Assertion is correct, but the Reason is incorrect", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/m2e8KoB2aj9SJYZk5Zvv1739961642.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rupture of the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> <span class=\"customMeta\" data-dictid=\"31f0ff95651692777181fcca56acfe\">albuginea</span> surrounding the <span class=\"customMeta\" data-dictid=\"8c62bbe6721692777185d6892c1f31\">corpora</span> cavernosa, typically due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma to an erect penis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Triad Symptoms:</p>\n<ul>\n<li>Audible Pop or Crack: Reported during trauma.</li>\n<li>Pain: Severe at the time of injury.</li>\n<li>Swelling and Bruising: Noticeable <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and discoloration.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alok Atreya, Suman Baral\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.4786\" data-tags=\"\" height=\"194\" src=\"https://image.prepladder.com/content/m2e8KoB2aj9SJYZk5Zvv1739961642.png\" width=\"298\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p><strong>Eggplant Deformity</strong>:</p>\n<ul>\n<li>Characteristic appearance due to extensive <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and hematoma, associated with significant pain and discoloration.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Blood at Urethral Meatus: Indicates possible urethral injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physical Examination: Initial assessment.</li>\n<li>Ultrasound: Evaluates injury extent and hematomas.</li>\n<li>Retrograde Urethrogram (RGU): Checks for urethral injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate Care:</p>\n<ul>\n<li>Ice packs to reduce swelling</li>\n<li>Pain management with analgesics</li>\n</ul>\n<p>Surgical Intervention:</p>\n<ul>\n<li>Repair of the ruptured <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> <span class=\"customMeta\" data-dictid=\"31f0ff95651692777181fcca56acfe\">albuginea</span> and any urethral injury</li>\n</ul>\n<p>Postoperative Care:</p>\n<ul>\n<li>Antibiotics to prevent infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Penile Deformity: Possible <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> or fibrosis.</li>\n<li>Erectile Dysfunction: Potential if injury or repair is inadequate.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cmeCl50cQ8EWSX2dfgdx1745397425.mp3", "video": ""}, {"text": "A 28-year-old male was involved in a high-speed motor vehicle accident. On examination, he has a high-riding prostate on rectal exam, and blood is noted at the urethral meatus. He complains of difficulty in urination, and imaging reveals a pelvic fracture. Retrograde urethrography confirms a complete disruption of the posterior urethra. After initial stabilization, Which of the following is the most definitive method of management for this patient?", "options": [{"label": "A", "text": "Immediate Surgical Repair of the Urethra", "correct": false}, {"label": "B", "text": "Suprapubic Catheter Placement Alone", "correct": false}, {"label": "C", "text": "Delayed Urethroplasty 3 months post-injury", "correct": true}, {"label": "D", "text": "Long-term Foley Catheterization", "correct": false}], "correct_answer": "C. Delayed Urethroplasty 3 months post-injury", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Urethral Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior Urethral Injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Minor Injuries:</strong> Managed conservatively with <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> if severe bruising</li>\n<li><strong>Severe Injuries:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention like primary repair, urethroplasty, or end-to-end anastomosis</li>\n<li><strong>Antibiotics: </strong>To prevent infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Initial Management:</strong> <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">Suprapubic</span> <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> diversion</li>\n<li><strong>Delayed <span class=\"customMeta\" data-dictid=\"efb09641831692777201e1dcdc5f83\">Urethroplasty</span> (Definitive management):</strong> 3-6 months post-injury after <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> have subsided</li>\n<li><strong>Primary Realignment:</strong> Occasionally attempted if conditions permit</li>\n<li><strong>Endoscopic Realignment:</strong> For selected cases, though often reserved for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Urethral <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> </strong>(risk of recurrence)</li>\n<li><strong>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> </strong>(especially if injury near the penile base)</li>\n<li><strong>Urinary incontinence</strong> (less common)</li>\n<li><strong>Infection </strong>(urethritis or <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Urethral <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> </strong>(most common long-term complication)</li>\n<li><strong>Urinary incontinence</strong> (due to <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> damage)</li>\n<li><strong>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> </strong>(common, due to injury near <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> structures)</li>\n<li><strong>Bladder neck contracture</strong></li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> syndrome</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pY2W8c2j3yLgpb0Ncpps1748694342.mp3", "video": ""}, {"text": "Which of the following is the least dilatable part of the male urethra?", "options": [{"label": "A", "text": "Prostatic urethra", "correct": false}, {"label": "B", "text": "Membranous urethra", "correct": false}, {"label": "C", "text": "Penile (spongy) urethra", "correct": false}, {"label": "D", "text": "Urethral meatus", "correct": true}], "correct_answer": "D. Urethral meatus", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Part of Urethra</th>\n<th>Location</th>\n<th>Dilatability</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Prostatic urethra (Option A ruled out)</strong></td>\n<td>Passes through <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> gland</td>\n<td><strong>Most dilatable</strong></td>\n</tr>\n<tr>\n<td><strong>Membranous urethra (Option B ruled out)</strong></td>\n<td>Passes through <span class=\"customMeta\" data-dictid=\"2942e9d19616927772014161ee8f70\">urogenital</span> diaphragm</td>\n<td>Least dilatable <strong>internally</strong> due to being surrounded by external sphincter</td>\n</tr>\n<tr>\n<td><strong>Penile (spongy) <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Option C ruled out)</strong></td>\n<td>Within the <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> spongiosum of the penis</td>\n<td>Moderately dilatable</td>\n</tr>\n<tr>\n<td><strong>Urethral meatus</strong></td>\n<td>External opening of urethra</td>\n<td><strong>Least dilatable overall</strong></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b1MdYNp8AiUpidxqb91Y1748691205.mp3", "video": ""}, {"text": "A 35-year-old male presents with an erection lasting over 6 hours and initial aspiration fails to resolve the condition. What is the next appropriate step in the management of this patient?", "options": [{"label": "A", "text": "Oral phosphodiesterase inhibitors", "correct": false}, {"label": "B", "text": "Observation", "correct": false}, {"label": "C", "text": "Intracavernosal phenylephrine injection", "correct": true}, {"label": "D", "text": "Penile prosthesis placement", "correct": false}], "correct_answer": "C. Intracavernosal phenylephrine injection", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SMMZe3R5PqBch8Q76qAp1739961310.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Od6OEft3PEuri8Zfp8xA1748693884.mp3", "video": ""}, {"text": "A 30 year old male presents with a painless erection following a penile trauma. Doppler ultrasound confirms the presence of blood flow and blood gas analysis shows arterial blood characteristics. What is the most likely type of priapism?", "options": [{"label": "A", "text": "Ischaemic priapism", "correct": false}, {"label": "B", "text": "Non-ischaemic priapism", "correct": true}, {"label": "C", "text": "Neurogenic priapism", "correct": false}, {"label": "D", "text": "Recurrent priapism", "correct": false}], "correct_answer": "B. Non-ischaemic priapism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ischemic Priapism (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nonischemic Priapism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative Names</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-flow, Anoxic, Veno-occlusive.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-flow, Arterial.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Commonality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, often painful.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual, less painful.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with sickle cell disease, medications (anticoagulants, antihypertensives, antidepressants, PDE5 inhibitors, intracavernous injections, alpha-blockers, methylphenidate, atomoxetine, cocaine), blood disorders (leukemia, thalassemia, multiple myeloma, thrombotic thrombocytopenic purpura).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often due to trauma (Perineal, pelvic, or penile trauma) or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> arterial malformations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Flow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased or absent (leading to <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> and acidosis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (blood is well-oxygenated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cavernosal Blood Gas Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dark blood, pH &lt;7.25, PO2 &lt;30 mmHg, PCO2 &gt;60 mmHg.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bright red blood, normal pH, normal PO2 and PCO2.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Doppler Ultrasonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal or no <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> in the <span class=\"customMeta\" data-dictid=\"8c62bbe6721692777185d6892c1f31\">corpora</span> cavernosa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal to increased blood flow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urgency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medical emergency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not an emergency, often resolves spontaneously.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of tissue damage, <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and long-term <span class=\"customMeta\" data-dictid=\"5cc2a2112e16927771874c5d97065a\">erectile</span> dysfunction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely causes permanent damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intracavernosal <span class=\"customMeta\" data-dictid=\"504306528f1692777199a0b2437267\">sympathomimetic</span> drugs (e.g., phenylephrine)</li>\n<li>Aspiration and irrigation.</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> or <span class=\"customMeta\" data-dictid=\"25ce10635b1692777195c7851c758e\">penile prosthesis</span> if refractory.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Observation</li>\n<li>Arteriography and <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> if intervention is desired.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor if untreated within 24-48 hours, leading to <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> <span class=\"customMeta\" data-dictid=\"5cc2a2112e16927771874c5d97065a\">erectile</span> dysfunction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good, often resolves without long-term sequelae.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NZbY1aw80rKNhnzWn6LK1747830754.mp3", "video": ""}, {"text": "A 60-year-old male presents to the emergency department with severe pain and swelling of the glans penis after retracting his foreskin for catheterization. The foreskin is stuck behind the glans with visible constriction. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Circumcision", "correct": false}, {"label": "B", "text": "Manual reduction using compression methods", "correct": true}, {"label": "C", "text": "Topical corticosteroid application", "correct": false}, {"label": "D", "text": "Oral antibiotics", "correct": false}], "correct_answer": "B. Manual reduction using compression methods", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Paraphimosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A urologic emergency where the retracted <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> becomes trapped behind the glans, leading to potential complications like strangulation, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compromise and necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iatrogenic causes (e.g., catheterization, cystoscopy, routine cleaning)</li>\n<li>Penile trauma</li>\n<li>Self-inflicted injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> and <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> when the <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> is retracted for an extended period leads to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> flow leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and potential <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> if untreated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling and pain in the <span class=\"customMeta\" data-dictid=\"e62ab50e7a16927771882c6a886b18\">glans</span> and foreskin.</li>\n<li>Erythema (redness)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on history of <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> and <span class=\"customMeta\" data-dictid=\"27ac5e3413169277719548c1b36288\">physical examination</span> showing the <span class=\"customMeta\" data-dictid=\"e62ab50e7a16927771882c6a886b18\">glans</span> and a constricting band of tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Manual Reduction: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> methods to reduce <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and Osmotic agents (e.g., sugar or mannitol) to reduce edema.</li>\n<li>Surgical Options: <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> procedure to relieve pressure and circumcision for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> paraphimosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YtIFUMTViYQ84tkE0Whb1748693605.mp3", "video": ""}, {"text": "A 5 year old boy presents with a non-retractable foreskin that has a fibrotic ring around the preputial orifice. His parents report that he experiences pain and irritation during urination. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Physiologic phimosis", "correct": false}, {"label": "B", "text": "Paraphimosis", "correct": false}, {"label": "C", "text": "Pathologic phimosis", "correct": true}, {"label": "D", "text": "Balanitis", "correct": false}], "correct_answer": "C. Pathologic phimosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Physiologic <span class=\"customMeta\" data-dictid=\"58c3985ce116927771952e5c09747d\">Phimosis</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathologic <span class=\"customMeta\" data-dictid=\"58c3985ce116927771952e5c09747d\">Phimosis</span> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inability to retract the <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> due to <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> adhesions.</li>\n<li>Common in newborns and young boys</li>\n<li>Resolves spontaneously over time with normal penile growth and erections.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nonretractable <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> due to <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> or <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> of the prepuce.</li>\n<li>Less common, typically occurs in older children or adults.</li>\n<li>Does not resolve spontaneously, often worsens without intervention.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present at birth, with gradual improvement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May develop after trauma, infection, inflammation, or forcible retraction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically asymptomatic, occasional mild discomfort during retraction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, irritation, bleeding, dysuria, painful erections, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance of Prepuce</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal appearance, <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> adhered to glans.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of fibrotic ring (cicatrix) around the <span class=\"customMeta\" data-dictid=\"13666285c216927771967d2dbd3027\">preputial</span> <span class=\"customMeta\" data-dictid=\"1aca482e7e169277719443d10dbe5f\">orifice</span> and white scarring.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed for most cases.</p>\n<p>Stretching exercises and <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> corticosteroids if concerned.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical options like preputioplasty, dilation, or <span class=\"customMeta\" data-dictid=\"d8a62b042216927771848a85d869e9\">circumcision</span> if severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of complications such as paraphimosis, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTIs, or <span class=\"customMeta\" data-dictid=\"67c78611fc1692777182807da0ac67\">balanitis</span> xerotica obliterans (BXO).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ppPfKpWv6Gi1Mn6Q47n41748693363.mp3", "video": ""}, {"text": "A newborn male presents with urinary retention, lethargy and a distended bladder. Antenatal ultrasound showed a \"keyhole sign\" with a thickened bladder wall. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypospadias", "correct": false}, {"label": "B", "text": "Vesicoureteral reflux", "correct": false}, {"label": "C", "text": "Posterior urethral valves", "correct": true}, {"label": "D", "text": "Neurogenic bladder", "correct": false}], "correct_answer": "C. Posterior urethral valves", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior urethral valves </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants from membranous folds in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> urethra.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> from oligohydramnios.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> urethral folds</p>\n<p>Type II: Membranes at <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck</p>\n<p>Type III: Round <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> at verumontanum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital, unclear embryological origin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> pressure → hypertrophy, <span class=\"customMeta\" data-dictid=\"639b2545551692777201eeadb06d68\">vesicoureteric</span> reflux, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tools</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound, <span class=\"customMeta\" data-dictid=\"1fbf40a1d316927772018a8e73e615\">VCUG</span> (voiding cystourethrogram) and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> scintigraphy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antenatal Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Dilated <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (\"keyhole sign\"), thickened walls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postnatal Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary retention, infections, lethargy, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antenatal: Vesicostomy, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> ablation</li>\n<li>Postnatal: Stabilization, <span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\">cystoscopic</span> ablation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on severity; long-term care needed for CKD, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> dysfunction, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTIs.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vxMLUYczv86TBZQrQQo11748693131.mp3", "video": ""}, {"text": "A 4-year-old boy presents with complaints of recurrent UTI and difficulty urinating as mentioned by their parents.Upon examination, the physician notes that the urethral opening is located on the dorsal (top) aspect of the penis rather than at the tip. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypospadias", "correct": false}, {"label": "B", "text": "Peyronie’s disease", "correct": false}, {"label": "C", "text": "Epispadias", "correct": true}, {"label": "D", "text": "Phimosis", "correct": false}], "correct_answer": "C. Epispadias", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qb8lMXWyqWfQnrYgPVTu1739961174.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VQqrClwQFUAPmyE6WPdK1748692978.mp3", "video": ""}, {"text": "A 4-year-old boy presents with recurrent urinary tract infections and a history of abnormal urination. Physical examination reveals an abnormal opening on the perineum instead of the tip of the penis. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypospadias", "correct": true}, {"label": "B", "text": "Epispadias", "correct": false}, {"label": "C", "text": "Ectopic vesicae", "correct": false}, {"label": "D", "text": "Phimosis", "correct": false}], "correct_answer": "A. Hypospadias", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DCLZRVPgvKOkYP3eTPGS1748271423.png"], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Feature</strong></th>\n<th><strong>Description</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> where the <strong>urethral <span class=\"customMeta\" data-dictid=\"6da3f0528c1692777192e9b608d735\">meatus</span> opens on the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> side</strong> (underside) of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> instead of the tip</td>\n</tr>\n<tr>\n<td><strong>Location of Meatus</strong></td>\n<td>Anywhere along the <strong>ventral shaft</strong>, scrotum, or <strong>perineum</strong> (in severe cases)</td>\n</tr>\n<tr>\n<td><strong>Types</strong></td>\n<td><strong>Glanular</strong> (near glans) <strong>Coronal</strong> <strong>Penile</strong> <strong>Penoscrotal</strong> <strong>Perineal</strong></td>\n</tr>\n<tr>\n<td><strong>Associated Abnormalities</strong></td>\n<td><strong>Chordee</strong> (ventral penile curvature) Incomplete <span class=\"customMeta\" data-dictid=\"152a4f2cde169277720378b9628a4b\">foreskin</span> (dorsal hood) Undescended <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> (in some cases)</td>\n</tr>\n<tr>\n<td><strong>Clinical Features</strong></td>\n<td><strong>Abnormal <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stream</strong> <strong>Spraying</strong> or <strong>dribbling</strong> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> May be noticed during <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> or <span class=\"customMeta\" data-dictid=\"d8a62b042216927771848a85d869e9\">circumcision</span> <strong>Recurrent UTIs</strong> (in severe cases)</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td><strong>Clinical examination</strong> at birth <strong>Imaging (USG KUB, VCUG)</strong> if suspected associated anomalies or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTIs</td>\n</tr>\n<tr>\n<td><strong>Differential Diagnoses</strong></td>\n<td><strong>Epispadias</strong> (dorsal meatus) <strong>Exstrophy of bladder</strong> <strong>Disorders of sexual development</strong> (if associated <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> ambiguity)</td>\n</tr>\n<tr>\n<td><strong>Management</strong></td>\n<td><strong>Avoid <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> circumcision</strong> (foreskin may be needed for repair) <strong>Surgical correction</strong> ideally between <strong>6–18 months of age</strong></td>\n</tr>\n<tr>\n<td><strong>Surgical Goals</strong></td>\n<td>Position urethral <span class=\"customMeta\" data-dictid=\"6da3f0528c1692777192e9b608d735\">meatus</span> at the <span class=\"customMeta\" data-dictid=\"e62ab50e7a16927771882c6a886b18\">glans</span> tip Straighten the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> (correct chordee) Create cosmetically normal appearance</td>\n</tr>\n<tr>\n<td><strong>Prognosis</strong></td>\n<td>Excellent with early <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> Most children have <strong>normal voiding and sexual function</strong> later in life</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jvZVqBIS1AdkgqEdz7kV1748692839.mp3", "video": ""}, {"text": "What is the correct sequence of steps for hypospadias repair?", "options": [{"label": "A", "text": "Degloving, orthoplasty, urethroplasty, and glanuloplasty", "correct": true}, {"label": "B", "text": "Orthoplasty, degloving, urethroplasty, and glanuloplastyD", "correct": false}, {"label": "C", "text": "egloving, urethroplasty, orthoplasty, and glanuloplasty", "correct": false}, {"label": "D", "text": "Degloving, urethroplasty, glanuloplasty, and orthoplasty", "correct": false}], "correct_answer": "A. Degloving, orthoplasty, urethroplasty, and glanuloplasty", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/a8H9xO4zK7r4Xk5ev9Q51748692556.mp3", "video": ""}, {"text": "What is the most common type of hypospadias?", "options": [{"label": "A", "text": "Scrotal hypospadias", "correct": false}, {"label": "B", "text": "Glanular hypospadias", "correct": true}, {"label": "C", "text": "Penoscrotal hypospadias", "correct": false}, {"label": "D", "text": "Perineal hypospadias", "correct": false}], "correct_answer": "B. Glanular hypospadias", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mMSTsV1uOJZIHfz0Zbz61739960839.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7ba7jVmJKXbIOCqu2yfS1748691862.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 74-year-old man was diagnosed with squamous cell carcinoma of the bladder. Which of the following is the most likely risk factor for this type of bladder cancer?", "options": [{"label": "A", "text": "History of schistosomiasis.", "correct": true}, {"label": "B", "text": "Previous bladder augmentation surgery.", "correct": false}, {"label": "C", "text": "Occupational exposure to aromatic hydrocarbons.", "correct": false}, {"label": "D", "text": "Use of drugs like cyclophosphamide", "correct": false}], "correct_answer": "A. History of schistosomiasis.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Histologic Type of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transitional cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (&gt;97%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smoking</li>\n<li>Occupational exposure (aromatic hydrocarbons):\n\t\t\t\t<ul>\n<li>Rubber, paint and dyes, gas and <span class=\"customMeta\" data-dictid=\"3dabcf4a5b16927772000a8ba686e1\">tar</span> industries</li>\n<li>Hairdressers, plumbers, and painters <strong>(Option C)</strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Environmental carcinogens: Arsenic in drinking water</li>\n<li>Schistosomiasis (SCC &gt;&gt; transitional cell Ca)</li>\n<li>Drugs: Phenacetin, <span class=\"customMeta\" data-dictid=\"a6ed2a5f63169277718507c569e576\">Cyclophosphamide</span> <strong>(Option D)</strong></li>\n<li>Pelvic radiotherapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Squamous Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (1-7%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Schistosomiasis <strong>(Option A)</strong></li>\n<li>Secondary to chronic infections:</li>\n</ul>\n<ul>\n<li>Indwelling catheter</li>\n<li>Bladder stone</li>\n<li>Recurrent infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenocarcinoma (2%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urachus</li>\n<li>Augmentation enterocystoplasty</li>\n<li>Bladder <span class=\"customMeta\" data-dictid=\"e4594c71ba169277718710293e2f1e\">exstrophy</span> repair <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare (&lt;1%): Melanoma, lymphoma, sarcoma, small cell carcinoma, pheochromocytoma, metastatic adenocarcinoma.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZYQE7kuhZtllpx3JnDM41748686621.mp3", "video": ""}, {"text": "A patient who had undergone cystectomy and urinary diversion with an ileal conduit after being diagnosed with muscle-invasive bladder cancer comes for follow-up. His blood investigations revealed an electrolyte imbalance. Which of the following is not a possible imbalance in this condition?", "options": [{"label": "A", "text": "Hypokalemia", "correct": false}, {"label": "B", "text": "Hyponatremia", "correct": true}, {"label": "C", "text": "Hypocalcemia", "correct": false}, {"label": "D", "text": "Hypomagnesemia", "correct": false}], "correct_answer": "B. Hyponatremia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ileum vs. <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">Colon</span> Absorption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ileum: </strong>Absorbs less chloride, more potassium</li>\n<li><strong>Colon</strong>: Absorbs more chloride, less potassium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrolyte Imbalances in <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypokalemia </strong><strong>(Option A)</strong>: Low <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels due to intestinal losses and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> wasting.</li>\n<li><strong>Hypocalcemia</strong><strong> (Option C)</strong>: Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels due to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> and bone demineralization.</li>\n<li><strong>Hypomagnesemia </strong><strong>(Option D)</strong>: Low <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> levels due to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> wasting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperchloremic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ammonium <span class=\"customMeta\" data-dictid=\"4b2f2a6d0a16927771902f60fa9ff7\">Ion</span> Dissociation</strong>: <span class=\"customMeta\" data-dictid=\"3719e878a4169277718109b2d3f67e\">Ammonium</span> (NH4+) dissociates into <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> (NH3) and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> ions (H+).</li>\n<li><strong>Ammonia Handling</strong>: <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">Ammonia</span> enters cells, and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> ions are actively absorbed in exchange for sodium</li>\n<li><strong>Ammonium Absorption</strong>: <span class=\"customMeta\" data-dictid=\"3719e878a4169277718109b2d3f67e\">Ammonium</span> can enter cells via <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> channels, substituting potassium.</li>\n<li><strong>Chloride Absorption</strong>: Balanced by the <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of chloride, leading to hyperchloremic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> and <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> loss.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypocalcemia Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bone Buffering</strong>: Chronic <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> is buffered by bone carbonate, releasing <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> from bones.</li>\n<li><strong>Bone Demineralization</strong>: <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> released from bone is not reabsorbed, leading to decreased body <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> stores.</li>\n<li><strong>Renal Wasting</strong>: Increased <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> loss of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> contributes to hypocalcemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effects of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> Diversion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> following <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> leads to continuous <span class=\"customMeta\" data-dictid=\"b1b457815716927771833294a8f64f\">buffering</span> by bone carbonate, causing bone demineralization.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8dDUxbZejh1XgpwJRlWG1748688819.mp3", "video": ""}, {"text": "A new mother comes to the outpatient department with her neonate as she notices intermittent fluid leaking from the umbilicus of the baby. On examination, the umbilicus is inflamed, enlarged, and there is delayed healing of the cord stump. What is the diagnosis?", "options": [{"label": "A", "text": "Patent urachus", "correct": true}, {"label": "B", "text": "Urachal cyst", "correct": false}, {"label": "C", "text": "Umbilical-urachal sinus", "correct": false}, {"label": "D", "text": "Vesico-urachal diverticulum", "correct": false}], "correct_answer": "A. Patent urachus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hfzUrmw4Eb0jWjfBBnAc1739966903.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Xi9EqoQluMHNmF0SxCNv1748688539.mp3", "video": ""}, {"text": "A 55-year-old male with non-muscle invasive bladder carcinoma is advised TURBT and BCG immunotherapy due to a high risk of recurrence. Which condition is not a contraindication for BCG therapy?", "options": [{"label": "A", "text": "Immunocompromised", "correct": false}, {"label": "B", "text": "Immediately after TURBT", "correct": false}, {"label": "C", "text": "Total urinary incontinence", "correct": false}, {"label": "D", "text": "Previous history of tuberculosis", "correct": true}], "correct_answer": "D. Previous history of tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Administration </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intravesical instillations: Administered postoperatively</li>\n<li>Induction therapy: Weekly for 6 weeks</li>\n<li>Maintenance therapy: Every 3 weeks for 3 years (variable intervals for 1-3 years)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BCG Therapy: Administered 6 weeks post-operatively, not immediately. <strong>(Option B)</strong></li>\n</ul>\n<ul>\n<li>Mitomycin C: Given immediately post-operatively.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Agents </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BCG (Bacillus Calmette-Guérin): Live attenuated vaccine.</li>\n<li>Mitomycin C: <span class=\"customMeta\" data-dictid=\"dcbc4c1178169277718125c5c1cc12\">Antineoplastic</span> agent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BCG Therapy: Elicits a massive influx of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells and cytokines, inducing an <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response against <span class=\"customMeta\" data-dictid=\"c82360aadd16927771936d67fa30a4\">neoplastic</span> cells.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transient fever</li>\n<li>Frequency</li>\n<li>Dysuria</li>\n<li>Urgency</li>\n<li>BCG Cystitis</li>\n<li>BCG Sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immunocompromised Patients:</strong> <strong>(Option A)</strong> Risk of <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> sepsis; requires a competent immune system.</li>\n<li><strong>Gross Hematuria:</strong> Risk of <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> entering <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> and causing <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infection.</li>\n<li><strong>Total <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">Incontinence</span> </strong><strong>(Option C)</strong><strong>:</strong> <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> is ineffective if it cannot remain in the bladder.</li>\n<li><strong>History of Previous <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">Sepsis</span> or Hypersensitivity:</strong> Risk of severe reactions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> Agents Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cisplatin or gemcitabine and cisplatin.</li>\n<li>Methotrexate</li>\n<li>Vinblastine</li>\n<li>Doxorubicin (Adriamycin)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravesical <span class=\"customMeta\" data-dictid=\"dcbc4c1178169277718125c5c1cc12\">antineoplastic</span> agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mitomycin C</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ScWDaVpz9VIc66YZTjhz1748688260.mp3", "video": ""}, {"text": "During a radical cystectomy for bladder cancer in males, which of the following structures is typically spared and not removed?", "options": [{"label": "A", "text": "Seminal Vesicles", "correct": false}, {"label": "B", "text": "Prostate", "correct": false}, {"label": "C", "text": "Urethra", "correct": false}, {"label": "D", "text": "Testes", "correct": true}], "correct_answer": "D. Testes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Bw1oRYW73xP5HJoOcTr11739966824.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Structures Removed During Radical Cystectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Indications for Radical Cystectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Indications for Partial Cystectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Entire Bladder</li>\n<li>Prostate (Males)</li>\n<li>Seminal Vesicles (Males)</li>\n<li>Urethra</li>\n<li>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes</li>\n<li>Uterus and Ovaries (Females)</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Invasive <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Cancer</strong>: Spread beyond the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> lining</li>\n<li><strong>Non-Muscle <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Cancer</strong>: <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> and unresponsive to other treatments</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Single Tumor</strong>: Confined to a single area of the bladder</li>\n<li><strong>Limited to <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Wall</strong>: Does not involve surrounding tissues or organs</li>\n<li><strong>Persistent or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> tumors </strong>in a <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> area</li>\n<li><strong>High-Grade Tumors</strong>: Confined to a specific area, does not involve deeper layers or distant sites</li>\n<li><strong>Preservation of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Function</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/X3V0mpQrksaFbH5sn1rm1748688062.mp3", "video": ""}, {"text": "Which of the following is the preferred initial therapy for a patient with carcinoma in situ (Tis) urinary bladder cancer after TURBT?", "options": [{"label": "A", "text": "Intravesical Gemcitabine (single instillation)", "correct": false}, {"label": "B", "text": "Intravesical Mitomycin (single instillation)", "correct": false}, {"label": "C", "text": "Intravesical BCG therapy", "correct": true}, {"label": "D", "text": "Immediate Cystectomy", "correct": false}], "correct_answer": "C. Intravesical BCG therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Tumor Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tis (Carcinoma in situ)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>TURBT (Transurethral <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Tumor)</strong></p>\n<ul>\n<li>May be used for initial diagnosis and tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> if not already performed</li>\n</ul>\n<p><strong>Intravesical BCG</strong></p>\n<ul>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Weekly for 3 weeks at months 3, 6, 12, 18, 24, 30, and 36</li>\n</ul>\n<p><strong>Continue <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> Maintenance Therapy</strong></p>\n<ul>\n<li>Up to 3 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ta (Non-muscle invasive)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>TURBT</strong></p>\n<ul>\n<li>Complete <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of tumor</li>\n</ul>\n<p><strong>Low-risk:</strong></p>\n<ul>\n<li>Single <span class=\"customMeta\" data-dictid=\"bcf4f8a2be16927771907cf5f046c5\">Instillation</span> (SI) of <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">Intravesical</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine, mitomycin)</li>\n<li>SI within 24 hours of TURBT</li>\n<li>Alternative: Continuous <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> irrigation</li>\n</ul>\n<p><strong>Intermediate-risk:</strong></p>\n<ul>\n<li>Intravesical <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine)</li>\n<li>Induction: 6 weekly courses</li>\n<li>Maintenance: Up to 1 year</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T1 (Muscle invasive)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>TURBT</strong>- For initial diagnosis and tumor debulking</p>\n<p><strong>High-risk:</strong></p>\n<ul>\n<li>Intravesical BCG</li>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Up to 3 years</li>\n</ul>\n<p><strong>Consider Cystectomy</strong></p>\n<ul>\n<li>If <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> is not tolerated or ineffective- Alternative: Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T2 (Muscle invasive)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>TURBT</strong>- May be used for tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and staging</p>\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Consider Cystectomy</li>\n<li>Alternatively, Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Depending on response and tumor characteristics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T3 (Advanced muscle invasive)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy with possible <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> chemotherapy</li>\n</ul>\n<p><strong>TURBT </strong>- Often not performed if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> is planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Based on <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> and staging</li>\n<li>Neoadjuvant therapy may continue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T4 (Locally advanced)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy</li>\n<li>Neoadjuvant Chemotherapy, if not yet administered</li>\n</ul>\n<p><strong>TURBT</strong>- Typically avoided if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> and <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> therapy are planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Additional <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or radiation based on <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> disease and staging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TStW6X3g7vPuTism4keU1748687926.mp3", "video": ""}, {"text": "Which of the following is not a tumor marker for urinary bladder cancer?", "options": [{"label": "A", "text": "Hyaluronidase (HYAL-1)", "correct": false}, {"label": "B", "text": "Nuclear Matrix Protein 22", "correct": false}, {"label": "C", "text": "Bladder Tumor Antigen", "correct": false}, {"label": "D", "text": "Alpha-fetoprotein", "correct": true}], "correct_answer": "D. Alpha-fetoprotein", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Investigations for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cystoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gold standard</strong> for <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer diagnosis and staging; suspicious lesions should be biopsied or resected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Urine Cytology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Used as an<strong> <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> to cystoscopy.</strong></p>\n<p>To confirm the diagnosis - has high <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> but low sensitivity.</p>\n<p>Detects <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">high-grade</span> urothelial <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> by identifying exfoliated cancer cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fluorescence Cystoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Enhances the <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of tumors but may have a<strong> higher <span class=\"customMeta\" data-dictid=\"b0151941a0169277720265b58da84e\">false-positive</span> rate.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CT scan is preferred </strong>for all stages;<strong> <span class=\"customMeta\" data-dictid=\"44b471ee361692777190ab7191df13\">IVP</span> is an alternative</strong> if CT is not available but is less commonly used.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:554px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Tumor Markers</strong></p>\n<p>Helpful in diagnosis and for follow-up to assist the response of therapy and to detect recurrence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NMP22 (Nuclear <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">Matrix</span> Protein 22)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Measures levels of a protein released from <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer cells into the urine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>BTA (Bladder Tumor Antigen)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Detects proteins associated with <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer in the urine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lewis X antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Immunocytological <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of the Lewis X <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> on exfoliated <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cells has improved the identification of urothelial tumor cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hyaluronidase</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Elevated levels of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> HA and HAase have been observed in patients with <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer.</p>\n<p>HYAL-1 <span class=\"customMeta\" data-dictid=\"366c3ddb8a169277718995d7c86490\">hyaluronidase</span> is a potential <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> marker for predicting muscle invasion and <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in non-muscle-invasive <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/i3ks9FRV85ogLE7OCdbt1748687764.mp3", "video": ""}, {"text": "A 62-year-old male with a bladder tumor invading the muscle layer is classified as which TNM stage?", "options": [{"label": "A", "text": "Ta", "correct": false}, {"label": "B", "text": "T1", "correct": false}, {"label": "C", "text": "T2", "correct": true}, {"label": "D", "text": "T3", "correct": false}], "correct_answer": "C. T2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Primary Tumor <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">Staging</span> (TNM System)</strong></p>\n<p>The depth of invasion of the primary tumor in <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer is a crucial <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> factor for <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> and progression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ta Lesions</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Papillary (exophytic) tumors with a tendency to recur.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tis Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>High-grade <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> neoplasms (carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> [CIS]) without invasion into <span class=\"customMeta\" data-dictid=\"94aff4fd141692777199a78b5ed2eb\">subepithelial</span> <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T1 Lesions</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tumors invade the <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> or <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria, typically high-grade.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T2 Lesions</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tumors invade muscle; <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> is standard therapy.</p>\n<p>Presence of muscle invasion increases the likelihood of nodal and distant metastases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T3 Lesions</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tumors extend beyond muscle into <span class=\"customMeta\" data-dictid=\"a8676d7c5116927771959fe0c9087b\">perivesical</span> fat. <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (CT, MRI, PET) may help identify disease spread outside the bladder.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>T4 Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tumors extend into adjacent organs.</p>\n<p><strong>T4a</strong> - invasion into the prostate, vagina, uterus, or bowel</p>\n<p><strong>T4b</strong> - tumors fixed to the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> wall, or other organs.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes &amp; Distant Metastases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Involvement of a single <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> within the true pelvis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Involvement of multiple <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes within the true pelvis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spread to the common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>M1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement beyond the common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>M1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Involvement of distant organs (non-lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> distant metastases).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PNyYPdFQ7xdlenUDnSI81748687615.mp3", "video": ""}, {"text": "A 62-year-old patient with muscle-invasive bladder cancer is undergoing evaluation for metastasis. What is the most common lymphatic node involved in bladder cancer metastasis?", "options": [{"label": "A", "text": "Supraclavicular nodes", "correct": false}, {"label": "B", "text": "Pelvic Nodes", "correct": true}, {"label": "C", "text": "Retroperitoneal Nodes", "correct": false}, {"label": "D", "text": "Intrathoracic Nodes", "correct": false}], "correct_answer": "B. Pelvic Nodes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route of metastasis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Direct extension into adjacent organs and/or the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> sidewall</li>\n<li>Lymphatic spread</li>\n<li>Hematogenous spread</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites of Metastasis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lymph Nodes (69%): <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> (m/c) <strong>&gt;</strong><strong> </strong>Retroperitoneal <strong>&gt;</strong> <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">Intrathoracic</span> <strong>&gt;</strong> <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">Supraclavicular</span> Nodes</li>\n<li>Bone (47%): <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">Lytic</span> lesions, <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> lesions or mixed lesions</li>\n<li>Lungs (37%): <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> nodules or consolidations</li>\n<li>Liver (26%): Multiple Lesions or <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">Solitary</span> Lesions</li>\n<li>Peritoneum (16%)</li>\n<li>Other Metastatic Sites: Soft tissue, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> glands, brain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tumors in a more advanced T category and those with <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> features <span class=\"customMeta\" data-dictid=\"c329085d1b1692777192eda410629f\">metastasize</span> earlier.</li>\n<li>Tumors with <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> features also have a higher frequency of peritoneal metastasis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/r5WKPFTyS0dRpP1Yriyi1748687450.mp3", "video": ""}, {"text": "A 65-year-old male with a history of smoking presents with frequent urination and microscopic hematuria. Cystoscopy reveals a flat, high-grade lesion confined to the bladder epithelium. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Papillary tumor", "correct": false}, {"label": "B", "text": "Carcinoma in situ", "correct": true}, {"label": "C", "text": "Stage T1 urothelial carcinoma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma of bladder", "correct": false}], "correct_answer": "B. Carcinoma in situ", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Fb7a4Txu5xOafKA3U9Re1739966638.png", "https://image.prepladder.com/content/tYCIeZLq2DLzQ3uP7K3x1739966654.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:579px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Papillary tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (CIS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A condition in which <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> cells are found in the tissue lining the inside of the bladder, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis, or ureter.</li>\n<li>Also called stage 0a <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer or stage 0a transitional cell cancer (Ta, N0, M0).</li>\n<li>Originate from <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> urothelial hyperplasia.</li>\n<li>Long, thin, finger-like growths under microscope. <strong>(Option A)</strong></li>\n<li>Can be low or high grade.</li>\n<li>May become cancer and spread to nearby normal tissue.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/Fb7a4Txu5xOafKA3U9Re1739966638.png\" width=\"4168\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Epithelial lesions that have <span class=\"customMeta\" data-dictid=\"5e1dc9e4e016927771853795d2b0be\">cytologic</span> features of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> but are confined to the epithelium, with no basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> invasion.</li>\n<li>Also called stage Tis <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer or stage Tis transitional cell cancer (Tis, N0, M0).</li>\n<li>High-grade, flat tumor on the bladder's inner lining, not invading deeper tissues.</li>\n<li><strong>Symptoms:</strong>\n<ul>\n<li>Dysuria</li>\n<li>Nocturia</li>\n<li>Frequent and urgent urination</li>\n<li>Microscopic <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> <strong>(Option B)</strong></li>\n</ul>\n</li>\n<li><strong>Diagnosis: </strong>Urine cytology, histopathology, <span class=\"customMeta\" data-dictid=\"c10a3cdda5169277718975a70a3479\">immunostaining</span> (CK 20, p53, CD44), and FISH for <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> abnormalities.</li>\n<li><strong>Treatment:</strong> <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">Intravesical</span> <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> preferred</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/tYCIeZLq2DLzQ3uP7K3x1739966654.png\" width=\"4168\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fG04y5szYYnTocRiOCQi1748687334.mp3", "video": ""}, {"text": "A 7-year-old boy with recurrent urinary tract infections (UTIs) is brought with a few episodes of hematuria and bladder discomfort. Imaging shows a diverticulum near the ureteric orifice. Which of the following statements is most accurate based on the clinical scenario?", "options": [{"label": "A", "text": "Congenital diverticulum due to its location and UTIs.", "correct": true}, {"label": "B", "text": "Occurs secondary to high intravesical pressure.", "correct": false}, {"label": "C", "text": "Immediate surgery is needed regardless of symptoms.", "correct": false}, {"label": "D", "text": "Thick-walled bladder with multiple diverticula.", "correct": false}], "correct_answer": "A. Congenital diverticulum due to its location and UTIs.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/86pcGCd2YgF3SgnaRVMG1739967192.png", "https://image.prepladder.com/content/P1ZLapyXPGq3x1UQqICz1739967115.png", "https://image.prepladder.com/content/HKDHpd1buHRbZphB2lU91739967233.png", "https://image.prepladder.com/content/WpIfHiyeZaZemCCFLMQE1739967276.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Congenital Diverticula</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acquired Diverticula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Develops due to <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> through <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> between the <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and roof of ureteral <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">hiatus</span> called <strong>Hutch diverticulum.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary to <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet obstruction, often due to prostatic issues in adult men.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bladder characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin-walled, typically located <strong>near the ureteric orifice, </strong>associated with <span class=\"customMeta\" data-dictid=\"2b8a1464c91692777201a347e52ce5\">vesicoureteral</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> (VUR) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thick-walled</strong><strong> </strong>with trabeculations and<strong> </strong><strong>multiple diverticula. (Option D)</strong></li>\n<li><strong>High <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> pressure </strong>causes <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> to protrude, forming saccules, which can become diverticula. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms or complications</strong></p>\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Haematuria (due to infection, stone or tumor) (30%)</li>\n<li>Recurrent UTIs</li>\n<li>Bladder stones</li>\n<li>Urinary retention</li>\n<li>Hydronephrosis</li>\n<li>Bladder tumors (1%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Imaging (ultrasound, CT, MRI, cystogram) or cystoscopy.</li>\n<li>Confirm <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with <span class=\"customMeta\" data-dictid=\"8e8c6c711516927772012e18876153\">urodynamics</span> if suspected.</li>\n</ul>\n<p>Bladder <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> MRI:</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sophie Elands Nikhil Vasdev James Adshead\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/MRI-bladder-confirming-tumour-within-bladder-diverticulum-to-be-organ-confirmed_fig3_267269823\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/86pcGCd2YgF3SgnaRVMG1739967192.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Bladder <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> CT:</p>\n<ul>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"The Radswiki◉\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/bladder-diverticulum-1\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/P1ZLapyXPGq3x1UQqICz1739967115.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Cystogram with <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> diverticulum:</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Amy Roy Nadim Bou Zgheib Joseph Assaley\" data-hash=\"\" data-license=\"CC BY ND\" data-source=\"https://www.researchgate.net/figure/Cystogram-showing-bladder-diverticulum-at-bladder-dome_fig1_318715603\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/HKDHpd1buHRbZphB2lU91739967233.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Cystoscopical view of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> diverticulum:</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Matković, Andro &amp; Ferenc, Thomas &amp; Jurjević, Nikolina &amp; Brkić, Filip &amp; Kavur, Lovro &amp; Jurenec, Franjo &amp; Mužinić, Darija &amp; Vidjak, Vinko. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Cystoscopy-findings-of-bladder-diverticulum-with-a-tumorous-mass_fig2_367052991\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/WpIfHiyeZaZemCCFLMQE1739967276.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"c9f59a135316927771862d79e1f59b\">diverticula</span> is <strong>treated if <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> or for suspected malignancy. (Option C)</strong></li>\n<li>Open surgery or minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> techniques for <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of diverticula; May require ureteric <span class=\"customMeta\" data-dictid=\"c6c1d34cf81692777197049241e98d\">reimplantation</span> based on <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> location.</li>\n<li>Repair is done <span class=\"customMeta\" data-dictid=\"b09d49618f169277718715136384d7\">extravesical</span> or through a combined <span class=\"customMeta\" data-dictid=\"b09d49618f169277718715136384d7\">extravesical</span> or <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> approach.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2JtzzRI12jr9R6iNMa4H1748686371.mp3", "video": ""}, {"text": "A 34-year-old male presents with severe abdominal pain and inability to urinate after a car accident. On examination, he has diffuse abdominal tenderness with guarding and rigidity. A cystogram reveals urine leakage into the peritoneal cavity. What is the next best step in management?", "options": [{"label": "A", "text": "Foley’s catheterisation and observation", "correct": false}, {"label": "B", "text": "Emergency laparotomy", "correct": true}, {"label": "C", "text": "IV antibiotics and close monitoring", "correct": false}, {"label": "D", "text": "Delayed surgical repair", "correct": false}], "correct_answer": "B. Emergency laparotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jEF8M7RMfPObugFctsNa1739966976.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Grade </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Injury </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Haematoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Contusion, <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">intramural</span> haematoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laceration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Partial thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laceration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Extraperitoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> wall <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> &lt;2 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laceration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Extraperitoneal ≥2 cm or <span class=\"customMeta\" data-dictid=\"e47e248094169277719000b0ed02ea\">intraperitoneal</span> &lt;2 cm <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> wall laceration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laceration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Intraperitoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> wall <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> ≥2 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laceration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laceration extending into the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck or ureteral <span class=\"customMeta\" data-dictid=\"1aca482e7e169277719443d10dbe5f\">orifice</span> (trigone)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9beJdLIrggcg5pRtmu0S1748686111.mp3", "video": ""}, {"text": "A 48-year-old female presents with chronic pelvic pain, urinary urgency, and frequency. On cystoscopy, a characteristic bladder lesion with a small capacity and visible mucosal breaks is noted. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bladder Cancer", "correct": false}, {"label": "B", "text": "Radiation Cystitis", "correct": false}, {"label": "C", "text": "Interstitial Cystitis with Hunner’s Lesion", "correct": true}, {"label": "D", "text": "Urinary Tract Infection", "correct": false}], "correct_answer": "C. Interstitial Cystitis with Hunner’s Lesion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Xr57phWxZMWonOOmEHZz1739965775.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystoscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hunner’s lesions (ulcerative lesions), small <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> capacity, and mucosal breaks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> urgency, frequency, nocturia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncertain, though associated with autoimmune, neurogenic, and allergic etiologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bladder cancer, UTI, Radiation cystitis, Endometriosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Behavioral therapy</li>\n<li>Pharmacotherapy (e.g., <span class=\"customMeta\" data-dictid=\"9950819263169277719579731837b0\">pentosan</span> polysulfate sodium)</li>\n<li>Intravesical therapies (e.g., <span class=\"customMeta\" data-dictid=\"9859613acd1692777187a2aaacae71\">GAG</span> layer replacement therapies, dimethyl sulfoxide)</li>\n<li>Surgical interventions (e.g., <span class=\"customMeta\" data-dictid=\"e06e32271216927772030141e67a00\">Fulguration</span> or laser therapy for Hunner lesions, <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> in severe cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5dLcBRALAM7DdKNrTbIL1748685619.mp3", "video": ""}, {"text": "Based on the images provided, where would each of the shown catheters be used? Image 1: Image 2:", "options": [{"label": "A", "text": "Image 1:Used for patients with acute urinary retention; Image 2:Used only in neurogenic bladder", "correct": false}, {"label": "B", "text": "Image 1: Used for patients with an enlarged prostate causing retention; Image 2: Used in cases of urethral stricture or trauma", "correct": true}, {"label": "C", "text": "Image 1: Used for short-term postoperative bladder drainage; Image 2:Used only when Foley's catheterization is contraindicated", "correct": false}, {"label": "D", "text": "Image 1: Used for patients with acute urinary retention; Image 2:Used for continuous bladder irrigation", "correct": false}], "correct_answer": "B. Image 1: Used for patients with an enlarged prostate causing retention; Image 2: Used in cases of urethral stricture or trauma", "question_images": ["https://image.prepladder.com/content/5ZaUuyrkCFHfhks95SLb1739964938.png", "https://image.prepladder.com/content/95QZCC2G97mDO4260sos1739964954.png"], "explanation_images": ["https://image.prepladder.com/content/Q5FpQoeIlaEFQdIwbUqk1739964998.png", "https://image.prepladder.com/content/Mx22uGCcG3wl0EOyCUIF1739964981.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:665px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Urinary catheters</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>General Information on Catheters</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Therapeutic Uses</strong>: Drug delivery, drainage, diagnostics.</p>\n<p><strong>Classification</strong>: Size, composition (silicone or latex-coated), number of channels.</p>\n<p><strong>Measurement</strong>: French scale, where 1 French (Fr) = 0.3 mm in diameter.</p>\n<p>The standard sizes are:</p>\n<ul>\n<li>Women: 12Fr or 14Fr &amp; Men: 16Fr</li>\n<li>Smaller sizes are used for urethral stricture.</li>\n<li>22Fr catheters are used for <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> with <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> retention.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Suprapubic Catheterization</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Suprapubic <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> (SPC) is the <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of a <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> into the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> through the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall above the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types of Urethral Catheters</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Single-Channel Catheters</strong>: One <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> channel, used for clean <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> self-catheterization, no <span class=\"customMeta\" data-dictid=\"3d7fbfbd7f1692777190bde80be811\">indwelling</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> mechanism.</p>\n<p><strong>Two-Channel Catheters</strong>: <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> channel + balloon inflation channel, standard for uncomplicated <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention.</p>\n<p><strong>Three-way Catheters</strong>: Additional channel for <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> irrigation, used for <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> retention, hematuria, post-bladder or <span class=\"customMeta\" data-dictid=\"041fb2c22116927772007921f33a1e\">transurethral</span> <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> surgery.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8ocSzcu62oVe5wyqmR5Z1748684378.mp3", "video": ""}, {"text": "A 35-year-old male presents to the emergency department after a motor vehicle accident with a pelvic fracture and gross hematuria. The CT cystogram showed the following characteristic findings. Which of the following statements regarding the diagnosis of this patient is incorrect?", "options": [{"label": "A", "text": "Retrograde cystography demonstrates extravasation of contrast limited to the perivesical space.", "correct": false}, {"label": "B", "text": "Catheter drainage for 10-14 days is the treatment of choice for uncomplicated cases.", "correct": false}, {"label": "C", "text": "Immediate surgical repair in cases of bladder neck injury.", "correct": false}, {"label": "D", "text": "Both urethral and suprapubic catheters are recommended in all cases.", "correct": true}], "correct_answer": "D. Both urethral and suprapubic catheters are recommended in all cases.", "question_images": ["https://image.prepladder.com/content/3nB86RHPV7WX4xF22fyP1739965870.png"], "explanation_images": ["https://image.prepladder.com/content/eDs1jKRJ1qJqGnBn170r1739965881.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female with recurrent UTIs and a history of chronic immunosuppression after a renal transplant presents with non-tender abdominal nodules. The biopsy shows histiocytes with basophilic inclusions staining positive for PAS and von Kossa stains. Which of the following is the most accurate statement regarding the diagnosis?", "options": [{"label": "A", "text": "Commonly associated with Gram-negative bacteria like E. coli", "correct": true}, {"label": "B", "text": "Characteristic histological feature is Langhans giant cells", "correct": false}, {"label": "C", "text": "Treated primarily with high-dose corticosteroids", "correct": false}, {"label": "D", "text": "Usually self-limiting and resolves without treatment", "correct": false}], "correct_answer": "A. Commonly associated with Gram-negative bacteria like E. coli", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FIfxu97Vcw0a19QjJU2W1739965665.png", "https://image.prepladder.com/content/VUYaOzXRiEfdOeIfaGUM1739965699.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Malakoplakia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Pathogen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Escherichia coli</em> (most common), other <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> bacteria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Von Hansemann cells (foamy histiocytes) with <span class=\"customMeta\" data-dictid=\"7dc4767f2f169277719266d296237e\">Michaelis-Gutmann bodies</span> (PAS-positive inclusions)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Inclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Michaelis-Gutmann bodies, which are <span class=\"customMeta\" data-dictid=\"0bc69d6cf8169277718209818c7522\">basophilic</span> <span class=\"customMeta\" data-dictid=\"45e0bd1529169277719054d85830ce\">intracytoplasmic</span> inclusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> with <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> acid-Schiff (PAS), von Kossa, and Perl’s stains</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunocompromised states, such as organ transplantation, HIV, diabetes, malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> tract, but can affect multiple organ systems</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibiotics (fluoroquinolones, trimethoprim-sulfamethoxazole), possible <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> excision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires treatment; may lead to complications if untreated; variable course with potential relapses</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tEfXfJDSJnFJaTMhjG921747830505.mp3", "video": ""}, {"text": "A 45-year-old male tourist from rural Egypt presents with recurrent hematuria and lower abdominal pain. A pelvic radiograph shows a circular calcification resembling a fetal head in the pelvis with associated faint calcification of the distal right ureter. What is the most likely diagnosis and appropriate next step?", "options": [{"label": "A", "text": "Bladder stones; perform cystoscopy", "correct": false}, {"label": "B", "text": "Chronic schistosomiasis; obtain urine microscopy for ova", "correct": true}, {"label": "C", "text": "Pelvic tuberculosis; order interferon-gamma release assay", "correct": false}, {"label": "D", "text": "Calcified bladder tumor; schedule CT urography", "correct": false}], "correct_answer": "B. Chronic schistosomiasis; obtain urine microscopy for ova", "question_images": ["https://image.prepladder.com/content/N86AbwNAB0jjvKhzdgN21739965376.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endemic regions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Africa, Middle-East (especially Egypt)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent hematuria, lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathognomonic radiographic sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Fetal head in pelvis\" appearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definitive <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> for ova</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potential long-term complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Squamous cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> of the bladder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fine ureteral calcifications, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> wall thickening</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6fMYqmrs9fkJSfyWcj0L1746105679.mp3", "video": ""}, {"text": "A 9-year-old boy from a rural area presents with suprapubic pain, increased urinary frequency, and occasional hematuria, with no incontinence or systemic symptoms. He appears thin, has normal external genitalia, and has no significant medical history. Imaging shows multiple small, smooth bladder stones. What is the most likely cause?", "options": [{"label": "A", "text": "Bladder outlet obstruction leading to urinary stasis", "correct": false}, {"label": "B", "text": "Infection with urease-producing bacteria", "correct": false}, {"label": "C", "text": "Nutritional deficiency", "correct": true}, {"label": "D", "text": "Foreign body presence in the bladder", "correct": false}], "correct_answer": "C. Nutritional deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MuyYY7ChAeq7BvUdsL9X1739965223.png", "https://image.prepladder.com/content/1ZZ6lyzo1CBTqHykQCEX1739965264.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Secondary <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Stones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nutritional <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (Vitamins A, B6, magnesium, protein-carbohydrate imbalance) <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bladder outlet obstruction, infection, foreign body presence <strong>(Option A, B, D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ammonium urate, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> oxalate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uric acid, <span class=\"customMeta\" data-dictid=\"0f125a33661692777199eec6125223\">struvite</span> (infection-related)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children in developing countries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults with <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> or infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or present with dysuria, hematuria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hematuria, dysuria, frequency and urgency,</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IUxOh7BOefXbD7RLeKbm1748685456.mp3", "video": ""}, {"text": "Which of the following statements about ectopia vesicae is correct?", "options": [{"label": "A", "text": "More common in females than males", "correct": false}, {"label": "B", "text": "Presents with normal urinary continence", "correct": false}, {"label": "C", "text": "Increased risk of urinary bladder adenocarcinoma", "correct": true}, {"label": "D", "text": "Resolves on its own without surgery", "correct": false}], "correct_answer": "C. Increased risk of urinary bladder adenocarcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zyFb9CFfEAtiWD8rZn8D1739965110.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:701px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Visible <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Exposure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> is exposed on the lower abdomen, typically above the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis, and can range from the exposed <span class=\"customMeta\" data-dictid=\"d89806ebbe1692777200b7b677e616\">trigone</span> to the entire bladder.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Genital Abnormalities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Males:</strong> <span class=\"customMeta\" data-dictid=\"09d15ca64a1692777187c47fbb9420\">Epispadias</span> (urethra opens on the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> side of the penis), short and broad penis, upward curvature</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Females</strong>: <span class=\"customMeta\" data-dictid=\"343a68152416927771839d51d6aebd\">Bifid</span> clitoris, separation of the <span class=\"customMeta\" data-dictid=\"99041e636a169277719121835ed133\">labia</span> minora, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> opening</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Abdominal Wall Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Absence of lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall muscles, widened <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis, <span class=\"customMeta\" data-dictid=\"691350b150169277718642f213fcc7\">diastasis</span> of <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscles</li>\n<li>Outward <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> bones</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> inguinal hernia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Urological</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Continuous leakage of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> </strong>due to the inability to close the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet. <span class=\"customMeta\" data-dictid=\"2b8a1464c91692777201a347e52ce5\">Vesicoureteral</span> reflux, possible <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> anomalies like <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> or hydronephrosis. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Anorectum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rectal prolapse</li>\n<li>Imperforate anus</li>\n<li>Shortened perineum</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OQqc8XHoTzceVF1N844B1748685160.mp3", "video": ""}, {"text": "A 70-year-old male with diabetes and Parkinson’s disease presents with a 6-month history of difficulty urinating, incomplete bladder emptying, and frequent nighttime urination. A post-void residual volume test shows significant urine retention. Which of the following conditions is least likely the primary cause of his chronic urinary retention?", "options": [{"label": "A", "text": "Parkinson’s disease", "correct": false}, {"label": "B", "text": "Diabetic neuropathy", "correct": false}, {"label": "C", "text": "Benign Prostatic Hyperplasia (BPH)", "correct": false}, {"label": "D", "text": "Overactive Bladder", "correct": true}], "correct_answer": "D. Overactive Bladder", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> Retention</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Painless inability to fully empty the bladder, leading to elevated post-void <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bladder outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (BOO)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes and Contributing Factors</strong></p>\n</td>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Benign Prostatic <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> (BPH)</li>\n<li>Bladder Neck Stenosis</li>\n<li>Detrusor underactivity</li>\n<li>Neurological Conditions: Disorders like Parkinson's, Alzheimer's, stroke, and MS affect <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> control.</li>\n<li>Diabetic neuropathy</li>\n<li>Medications: Drugs such as anticholinergics and β3-agonists impact <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> muscle function.</li>\n<li>Urethral Stricture</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complications</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Hydronephrosis</strong></li>\n<li><strong>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Infections (UTIs)</strong></li>\n<li><strong>Bladder Stones</strong></li>\n<li><strong>Bladder Damage</strong>: Persistent overstretching weakens the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> muscle.</li>\n<li><strong>Kidney Damage</strong></li>\n<li><strong>Overflow Incontinence</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Treatment is based on the underlying cause, which may include addressing <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet obstruction, managing <span class=\"customMeta\" data-dictid=\"80d318a6701692777186805934d86a\">detrusor</span> underactivity, and treating other contributing factors.</li>\n<li>Urgent <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> is required for patients with chronic <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> to facilitate <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function recovery, with the possibility of postobstructive diuresis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> Retention</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Painful, sudden inability to <span class=\"customMeta\" data-dictid=\"c0b5bbe709169277720177f8c58ad5\">urinate</span> despite a full bladder.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Benign Prostatic <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> (BPH)</strong>: Leading cause, especially in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> with a history of chronic retention.</li>\n<li><strong>Medications</strong>: Drugs like sympathomimetics, anesthetics, and opioids can impair <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> function.</li>\n<li><strong>Neurological Conditions</strong>: <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> events like stroke or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord injury</li>\n<li><strong>Urethral Stricture</strong></li>\n<li><strong>Blood Clots</strong></li>\n<li><strong>Fecal <span class=\"customMeta\" data-dictid=\"aff4ed4b661692777189b2ffa86327\">Impaction</span> </strong>from chronic constipation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Catheterization</strong>: Immediate <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> retention.</p>\n<p><strong>Postobstructive diuresis:</strong> Patients may experience a high <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output after catheterization, requiring careful fluid management and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> monitoring</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VXl6e3nvEzo63yRgvmrQ1748684618.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old male presents with painless hematuria and weight loss over the past six months. CECT reveals a 9 cm enhancing mass in the right kidney, with evidence of invasion into the renal vein. Histopathology shows cells with clear cytoplasm and a delicate network of vasculature. Which of the following is the most likely variant of renal cell carcinoma?", "options": [{"label": "A", "text": "Chromophobe renal cell carcinoma", "correct": false}, {"label": "B", "text": "Papillary renal cell carcinoma", "correct": false}, {"label": "C", "text": "Clear cell renal cell carcinoma", "correct": true}, {"label": "D", "text": "Collecting duct carcinoma", "correct": false}], "correct_answer": "C. Clear cell renal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification and salient features of variants of RCC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RCC Variants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salient features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clear cell <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (CCRCC (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common </strong>variant</li>\n<li>Usually sporadic</li>\n<li>May be associated with the <strong>loss of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 3p</strong> and a mutated von Hippel–Lindau gene</li>\n<li><strong>Macroscopic appearance:</strong> solid, golden-yellow tumor with areas of <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and necrosis.</li>\n<li><strong>Microscopy</strong>: cells have <strong>clear cytoplasm</strong> due to the presence of abundant lipids and glycogen, surrounded by a delicate network of vasculature.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Papillary <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Second most common variant</li>\n<li>It can be further divided into <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> and Type 2</li>\n<li><strong>Type 1 </strong>has small <span class=\"customMeta\" data-dictid=\"0bc69d6cf8169277718209818c7522\">basophilic</span> cells and <strong>Type 2 is </strong>characterized by large <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cells.</li>\n<li><strong>Type 1 </strong>has a<strong> better prognosis</strong> than type 2.</li>\n<li>Associated with mutations in the <strong>MET gene </strong>- <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>7, 17, or Y.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromophobe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arises from the <strong>intercalated cells </strong>of the collecting ducts.</li>\n<li><strong>Microscopy: </strong>Characterized by large <strong>polygonal cells </strong>with prominent cell membranes and pale cytoplasm.</li>\n<li><strong>Better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> </strong>compared to other types of RCC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> carcinoma</strong> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also known as <strong>Bellini <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> carcinoma. </strong></li>\n<li><strong>Rare and aggressive</strong> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of RCC that arises from the collecting ducts in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> medulla, hence <strong>centrally located.</strong></li>\n<li><strong>Poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rare and aggressive</li>\n<li><strong>Associated with <span class=\"customMeta\" data-dictid=\"eae0e23ef41692777198f15774290f\">sickle cell trait</span> </strong>in children</li>\n<li>Centrally located</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/euyhE1pk0HwvW8VmyBQf1748355347.mp3", "video": ""}, {"text": "A 70-year-old male with a history of hypertension is diagnosed with renal cell carcinoma (RCC) after a CT scan reveals a 5 cm tumor confined to the right kidney. His renal function is normal, and there is no evidence of metastasis. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Partial Nephrectomy", "correct": true}, {"label": "B", "text": "Radical Nephrectomy", "correct": false}, {"label": "C", "text": "Radiofrequency Ablation", "correct": false}, {"label": "D", "text": "Targeted Therapy", "correct": false}], "correct_answer": "A. Partial Nephrectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations for RCC:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasound (USG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial Imaging</p>\n<p>Helps distinguish between solid and <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> masses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast-enhanced CT (CECT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of choice</strong> for diagnosis and staging.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior at detecting tumor <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> into the <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> wall and the level of thrombus.</p>\n<p>Investigation of choice for detecting tumor thrombus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (CT or X-ray), Bone Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To rule out metastases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not routinely performed due to the risk of seeding and the high <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy of imaging.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment of RCC: RCCs are radio and chemo-resistant.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Nephrectomy</strong><strong>(Option A)</strong><strong>: </strong>Involves removing only the tumor while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</p>\n<p><strong>Indications: </strong>Larger tumors or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and Cryoablation: </strong>Involve destroying the tumor using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumors(T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ricmwUERaHmTHsrbKRU51748355624.mp3", "video": ""}, {"text": "A 28-year-old woman is incidentally found to have a horseshoe kidney during an abdominal CT scan. She has no symptoms. Which of the following complications is she at highest risk for developing?", "options": [{"label": "A", "text": "Pelviureteric junction obstruction", "correct": true}, {"label": "B", "text": "Renal cell carcinoma", "correct": false}, {"label": "C", "text": "Renal artery stenosis", "correct": false}, {"label": "D", "text": "Nephroptosis", "correct": false}], "correct_answer": "A. Pelviureteric junction obstruction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LmCwf0qxJ3e4nVE7RUgi1740022270.png", "https://image.prepladder.com/content/aucz2A38LSJ43V49I0g81740022369.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zb4tkYAEWUQ81o3DaEpC1748455291.mp3", "video": ""}, {"text": "A newborn presents with abdominal distension and respiratory distress. Ultrasound reveals bilaterally enlarged kidneys with multiple small cysts. Which of the following statements regarding the diagnosis is incorrect?", "options": [{"label": "A", "text": "It follows an autosomal recessive pattern of inheritance", "correct": false}, {"label": "B", "text": "The gene involved is the PKHD1 gene on chromosome 7", "correct": true}, {"label": "C", "text": "USG shows enlarged, echogenic kidneys, with poor corticomedullary differentiation", "correct": false}, {"label": "D", "text": "Hepatic fibrosis is the cause of death", "correct": false}], "correct_answer": "B. The gene involved is the PKHD1 gene on chromosome 7", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infantile <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">Polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PKHD1</strong> gene on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>6p12.2</strong> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal distension</li>\n<li>Respiratory distress</li>\n<li>Bilaterally enlarged kidneys</li>\n<li>Multiple small cysts (primarily in collecting ducts)</li>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> insufficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extrarenal Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> fibrosis</li>\n<li>Portal hypertension</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">Fibrosis</span> and hypoplasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ultrasound: Enlarged, <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> kidneys with poor <span class=\"customMeta\" data-dictid=\"ffaf5d05751692777185e49d0166d3\">corticomedullary</span> <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> <strong>(Option C)</strong></li>\n<li>Genetic testing for PKHD1 mutations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inevitably fatal</li>\n<li>Supportive care can be given</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main causes of death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> <strong>(Option D)</strong></li>\n<li>Respiratory insufficiency</li>\n<li>Renal failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MbyjmyWb4suZEPSlhpLw1748452507.mp3", "video": ""}, {"text": "Which of the following statements is incorrect regarding the investigations and treatment of Autosomal Dominant Polycystic Kidney Disease?", "options": [{"label": "A", "text": "CECT is the investigation of choice for ADPKD", "correct": false}, {"label": "B", "text": "IVP may show a \"spider leg\" or \"bell-shaped\" appearance in ADPKD", "correct": false}, {"label": "C", "text": "Rovsing's operation is the gold standard for management which involves the opening and evacuation of fluid from cysts in ADPKD", "correct": true}, {"label": "D", "text": "Treatment is only done when cysts are overdistended causing pain, hemorrhage &amp;amp; infection", "correct": false}], "correct_answer": "C. Rovsing's operation is the gold standard for management which involves the opening and evacuation of fluid from cysts in ADPKD", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice:</strong> CECT <strong>(Option A)</strong></li>\n<li><strong>Ultrasound: </strong>Confirms the presence of cysts</li>\n<li><strong>IVP (Intravenous Pyelogram):</strong></li>\n<li>Spider leg/Bell-shaped appearance <strong>(Option B)</strong></li>\n<li>Bubble appearance</li>\n<li>Swiss-cheese appearance</li>\n<li><strong>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine</strong>: Elevated</li>\n<li><strong>Urine:</strong> Shows low specific gravity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Wait and watch initially.</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention is required only after cysts get overdistended causing pain, hemorrhage, and infection. <strong>(Option D)</strong></li>\n<li><strong>Gold Standard:</strong> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Transplantation</li>\n<li><strong>Rovsing's Operation </strong><strong>(Option C)</strong><strong>:</strong> Deroofing of <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> in ADPKD. The <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> is exposed. The <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is opened. The fluid is evacuated.</li>\n<li>US-guided <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> &amp; <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">Laparoscopic</span> <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> is commonly done as a simpler approach</li>\n<li>Once <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure sets in, initial <span class=\"customMeta\" data-dictid=\"6ba3fb0ce51692777188eaf7843351\">hemodialysis</span> followed by <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is done and later <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> can be planned</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rovsing's Syndrome: </strong>Hyperextension of the spine in the <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> produces <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, nausea, and vomiting.</li>\n<li><strong>Rovsing Sign:</strong> Pain in right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> on pressing left <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> seen in appendicitis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ynp1QTkOyRCeZDqRVknU1748452266.mp3", "video": ""}, {"text": "A 6-month-old child undergoes a micturating cystourethrogram for suspected vesicoureteric reflux. The radiologist notes reflux into the renal pelvis with mild distention of the collecting system. Which grade of vesicoureteric reflux does this finding represent?", "options": [{"label": "A", "text": "Grade IV", "correct": false}, {"label": "B", "text": "Grade II", "correct": false}, {"label": "C", "text": "Grade III", "correct": true}, {"label": "D", "text": "Grade I", "correct": false}], "correct_answer": "C. Grade III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6RlM75XdWqtzll4Ts2tC1740022837.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chances of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution of VUR</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reflux into non-dilated ureter</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reflux into the <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> with <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> into the <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunting of <span class=\"customMeta\" data-dictid=\"a17eac40ea16927772034ca233cb84\">fornix</span> with <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> into the <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated and <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> with <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> into the <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/exHWOvGji3zHiVVtKBDw1748455958.mp3", "video": ""}, {"text": "A 4-year-old boy presents with recurrent urinary tract infections and a palpable kidney mass in the loin region. Further, the patient is diagnosed with vesicoureteric reflux on both sides. Which of the following is an incorrect statement regarding the management of this condition?", "options": [{"label": "A", "text": "Most cases resolve spontaneously without treatment", "correct": false}, {"label": "B", "text": "The investigation of choice is Intravenous Pyelogram", "correct": true}, {"label": "C", "text": "Symptomatic cases require surgical correction via ureteric reimplantation", "correct": false}, {"label": "D", "text": "Severe cases may require nephrectomy and renal transplantation", "correct": false}], "correct_answer": "B. The investigation of choice is Intravenous Pyelogram", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Congenital: </strong>Commonly associated with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> urethral valve</li>\n<li><strong>Acquired: </strong>Trauma due to surgery or intervention</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"210e94f8861692777201a0d6de4b0e\">UTI</span> and Pyelonephritis</li>\n<li>Palpable mass in the loin</li>\n<li>Renal failure in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal scarring</strong> if not managed in <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Micturating <span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\">cystourethrogram</span> (IOC)</strong></li>\n<li>Intravenous urography</li>\n<li>Urine <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> and C/S</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I to III-</strong> <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">Prophylaxis</span> as it resolves spontaneously in most patients. <strong>(Option A)</strong></p>\n<p><strong>Grade IV to V- </strong>Antibiotics + Surgery</p>\n<p>Only <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> via ureteric reimplantation. <strong>(Option B)</strong></p>\n<p><strong>Surgery:</strong></p>\n<ul>\n<li>Ureterovesicoplasty</li>\n<li>Ureteric <span class=\"customMeta\" data-dictid=\"c6c1d34cf81692777197049241e98d\">reimplantation</span> (Lich-Gregoir technique)</li>\n<li>STING Operation (Endoscopic)</li>\n</ul>\n<p>Severe cases may require <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> transplantation. <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/H99QbDJLW9YxeTcxr9vr1748455744.mp3", "video": ""}, {"text": "A 5-year-old girl is brought to the pediatric urology clinic by her mother, who reports that the child has \"never been dry\" since birth. The mother notes that urine dribbles continuously via the vagina, but the child can also pass urine normally. An intravenous urogram is performed which is attached below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Vesicoureteral reflux", "correct": false}, {"label": "B", "text": "Posterior urethral valves", "correct": false}, {"label": "C", "text": "Ectopic ureter from duplicated collecting system", "correct": true}, {"label": "D", "text": "Ureterocele", "correct": false}], "correct_answer": "C. Ectopic ureter from duplicated collecting system", "question_images": ["https://image.prepladder.com/content/Umxkwhtm68zHvBnKMSYN1740022640.png"], "explanation_images": ["https://image.prepladder.com/content/IFPYETl3GhtSfgea5VJD1740022684.png", "https://image.prepladder.com/content/hyCzQhifoBq8vF486ftc1740022731.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>MC <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomaly</strong> of the upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract</li>\n<li>Usually unilateral, common on the left side; More common in females</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Incomplete duplication</strong>\n<ul>\n<li>Bifid ureter</li>\n</ul>\n</li>\n<li><strong>Complete duplication</strong>\n<ul>\n<li><strong>Weigert Meyer’s Rule-</strong> <span class=\"customMeta\" data-dictid=\"49b9423f581692777201f707cbb8f5\">Upper pole ureter</span> is <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> compared to lower pole ureter.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In Males\n\t\t\t\t<ul>\n<li>Recurrent infections</li>\n</ul>\n</li>\n<li>In Females\n\t\t\t\t<ul>\n<li>Continuous <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (dribbling) with normal voiding pattern</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IOC for Dx is IVP</strong>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For complete duplication\n\t\t\t\t<ul>\n<li>Upper pole ureter- <strong>Ureterocele</strong></li>\n<li>Lower pole <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> - <strong>VUR </strong>(due to short <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> length)</li>\n</ul>\n</li>\n<li>For incomplete duplication, there is <strong>reno-renal reflux</strong> resulting in:\n\t\t\t\t<ul>\n<li>Infection</li>\n<li>Stone formation</li>\n<li>Hydronephrosis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For upper pole ureter: <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> + <span class=\"customMeta\" data-dictid=\"c6c1d34cf81692777197049241e98d\">Reimplantation</span> into bladder</li>\n<li>For lower pole ureter: <span class=\"customMeta\" data-dictid=\"4b0b1d789c1692777201448fa283d4\">Ureterovesicoplasty</span> (strengthening of uretero-vesical junction)</li>\n<li>Reimplantation of the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> ureter</li>\n<li>If there is upper pole <span class=\"customMeta\" data-dictid=\"441df40d111692777189b0e31acb06\">hydronephrosis</span> with no function: Upper pole <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> should be performed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Radiological Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #808080; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Yo-Yo reflux:</strong> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">Reflux</span> of contrast in both limbs of the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> on <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">pyelogram</span> in incomplete duplication</li>\n<li><strong>Drooping lily sign</strong>: Seen in <span class=\"customMeta\" data-dictid=\"a474651a3816927771869b71041ec1\">duplication</span> with <span class=\"customMeta\" data-dictid=\"142cff3afd1692777191ee3e887515\">malrotation</span> pelvis</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Gaillard F, Thibodeau R, Niknejad M\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/drooping-lily-sign-ureter\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/hyCzQhifoBq8vF486ftc1740022731.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BstMeswHbEAV5fwI7X3i1748455583.mp3", "video": ""}, {"text": "A 6-year-old boy presents with recurrent urinary tract infections and a palpable abdominal mass. Imaging reveals a cystic dilation near the ureteral orifice within the bladder. Which of the following best describes the underlying condition?", "options": [{"label": "A", "text": "Ureterocele", "correct": true}, {"label": "B", "text": "Bladder diverticulum", "correct": false}, {"label": "C", "text": "Ectopic ureter", "correct": false}, {"label": "D", "text": "Vesicoureteral reflux", "correct": false}], "correct_answer": "A. Ureterocele", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Wx3pl9PjubJu1VkbGVZr1740022518.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/n5ev7uFoqSsGTS6iv9md1748455411.mp3", "video": ""}, {"text": "A 40-year-old male presents with right-sided flank pain and persistent hematuria. An intravenous urogram is done and given below. What is the definitive management of this condition?", "options": [{"label": "A", "text": "Observation with serial imaging", "correct": false}, {"label": "B", "text": "Ureteric stent placement", "correct": false}, {"label": "C", "text": "Surgical repositioning of the ureter", "correct": true}, {"label": "D", "text": "Percutaneous nephrostomy", "correct": false}], "correct_answer": "C. Surgical repositioning of the ureter", "question_images": ["https://image.prepladder.com/content/4Kd5HOwU1PowFGBhKhuk1740022077.png"], "explanation_images": ["https://image.prepladder.com/content/1tGzZI8eicn5RUR0hy671740022148.png", "https://image.prepladder.com/content/ysdBZCNZaYg973MEsuGt1740022183.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/goFAFB0Zw5lRtF7e9S5H1748453001.mp3", "video": ""}, {"text": "A 35-year-old woman presents with intermittent left flank pain and episodes of gross hematuria. Imaging reveals a dilated renal pelvis with a narrowed ureteropelvic junction. Which of the following is the most appropriate long-term management?", "options": [{"label": "A", "text": "Percutaneous nephrostomy", "correct": false}, {"label": "B", "text": "Watchful waiting with regular monitoring", "correct": false}, {"label": "C", "text": "Pyeloplasty", "correct": true}, {"label": "D", "text": "Ureteric balloon dilatation", "correct": false}], "correct_answer": "C. Pyeloplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lHQ35tjowQms8Unpdg2Z1740022008.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Atresia/stenosis</strong> - Developmental <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> that leads to an <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> narrowing</li>\n<li><strong>Aberrant left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> artery</strong> - The presence of an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> compressing the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> externally</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Scarring from previous infections</li>\n<li><strong>Kidney stones</strong> <strong>(most common)</strong></li>\n<li>Surgery - <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> formation</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NYt1SahiPO1pFaKqNUAo1748452861.mp3", "video": ""}, {"text": "A 20-year-old pregnant woman undergoes an ultrasound at 22 weeks' gestation. The scan reveals severe oligohydramnios and the fetal kidneys are not visualized. Which of the following additional findings is most likely to be present in the fetus?", "options": [{"label": "A", "text": "Pulmonary hypoplasia", "correct": true}, {"label": "B", "text": "Normal lung development", "correct": false}, {"label": "C", "text": "Medullary sponge kidney", "correct": false}, {"label": "D", "text": "Enlarged fetal bladder", "correct": false}], "correct_answer": "A. Pulmonary hypoplasia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sh9OXM9EDxDQHSzJoxWK1740021907.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZZXDWkwNrWFccETiw2f61748452680.mp3", "video": ""}, {"text": "A 45-year-old woman with a history of tuberous sclerosis complex with angiomyolipoma (AML) presents with a sudden onset of severe left flank pain. On examination, she is hypotensive and has a tender left flank. Imaging reveals a large hemorrhage in the left kidney extending into the perirenal space. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pyelonephritis", "correct": false}, {"label": "B", "text": "Renal cell carcinoma", "correct": false}, {"label": "C", "text": "Wunderlich syndrome", "correct": true}, {"label": "D", "text": "Acute appendicitis", "correct": false}], "correct_answer": "C. Wunderlich syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Angiomyolipomas (AMLs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arise from</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Perivascular <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Most <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> AMLs are asymptomatic</strong>, discovered incidentally on imaging.</li>\n<li><strong>Sporadic AMLs:</strong> Present in the 4th-6th decades, typically small, solitary, and slow-growing.</li>\n<li><strong>TSC-associated AMLs:</strong> Present earlier (3rd-4th decades), larger, multiple, bilateral, and tend to grow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Common symptoms</strong>: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> or <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> pain, hematuria, hypertension, anemia, and impaired <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function, usually due to hemorrhage.</li>\n<li>Hemorrhage: Severe complication.</li>\n<li><strong>Wunderlich syndrome</strong>: nontraumatic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> hemorrhage.</li>\n<li>Risk factors for hemorrhage: <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> size (&gt;6 cm), increased vascularity, large <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> aneurysms (&gt;5 mm), and <span class=\"customMeta\" data-dictid=\"a6b9f7eebc16927771871910d2eb87\">exophytic</span> growth pattern.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Risk Factors for <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> Complications</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Pregnancy: </strong>Increased risk of <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> due to hormonal changes, increased blood volume, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li><strong>TSC-associated AMLs:</strong> Higher risk of <span class=\"customMeta\" data-dictid=\"e6dc8586b11692777184b083672593\">CKD</span> and ESKD, often due to <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> or embolization.</li>\n<li><strong>Epithelioid AMLs:</strong> Potential for <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation, metastasis, and local recurrence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<ul>\n<li><strong>CT: (Investigation of choice) </strong>Presence of <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> fat.</li>\n<li><strong>Ultrasound: </strong>Bright <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> mass <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on account of the high fat content. Used for monitoring <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> size.</li>\n<li><strong>MRI: </strong>T1 and T2 hyperintensity with <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> on <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> administration. In Phase/opposed phase imaging: <strong>India ink artifact. </strong>Useful mainly in fat poor AML.</li>\n<li><strong>Biopsy:</strong> Indicated if diagnosis is uncertain via <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> is suspected.</li>\n<li><strong>Immunocytochemical analysis: </strong>Useful for differentiating <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> from RCC, using markers like <strong>HMB-45</strong> and <strong>melan-A.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Observation: </strong>Suitable for tumors &lt;4 cm</li>\n<li><strong>Nephron-Sparing Surgery(Partial nephrectomy):</strong> Preferred for larger tumors or those with a high risk of bleeding</li>\n<li><strong>Angioembolization:</strong> Main treatment for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> hemorrhage, involves <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the tumor.</li>\n<li><strong>Medications:</strong> <strong>mTOR inhibitors</strong> like <span class=\"customMeta\" data-dictid=\"aa8d032496169277718724299fb4cb\">everolimus</span> and <span class=\"customMeta\" data-dictid=\"48e0de93231692777198177344736c\">sirolimus</span> are useful, especially in cases associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> complex.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FnLyzgMvrAMjsWEeRbWE1748355071.mp3", "video": ""}, {"text": "Which of the following statements is incorrect regarding Autosomal Dominant Polycystic Kidney Disease?", "options": [{"label": "A", "text": "The disease involves a mutation in the PKD1 and PKD2 genes on chromosomes 4 and 16 respectively", "correct": true}, {"label": "B", "text": "Hypertension is the most common manifestation", "correct": false}, {"label": "C", "text": "Cysts can be seen in the organs such as the ovary, and pancreas in patients with ADPKD", "correct": false}, {"label": "D", "text": "The most common extrarenal manifestation is polycystic liver disease", "correct": false}], "correct_answer": "A. The disease involves a mutation in the PKD1 and PKD2 genes on chromosomes 4 and 16 respectively", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by the growth of numerous cysts in the kidneys.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autosomal Dominant</li>\n<li>Involvement of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16 <strong>(PKD1)</strong> and 4 <strong>(PKD2)</strong></li>\n<li>Abnormal protein-<strong>Polycystin</strong></li>\n<li>Both kidneys are replaced by multiple cysts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both kidneys are replaced by multiple cysts</li>\n<li>The <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> loses its function of the concentration of urine</li>\n<li>Cysts in <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> → <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> of blood vessels → <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">Activation</span> of <span class=\"customMeta\" data-dictid=\"15d91786931692777197c8932c8000\">RAAS</span> → Hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features (Intrarenal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common manifestation</strong> is <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> <strong>(Option B)</strong></li>\n<li>Polyuria, Nocturia, Hematuria</li>\n<li>Nephrolithiasis</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure (Usually in the 5th to 6th decade)</li>\n<li>Any <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> in the <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system will lead to HIS (Hydronephrosis; Infection; Stone) → Hematuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features (Extrarenal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Polycystic Liver Disease <strong>(Most common) </strong><strong>(Option D)</strong></li>\n<li>Cyst in Ovary, Pancreas, <span class=\"customMeta\" data-dictid=\"6a4861c8d71692777199aeb1d55c85\">Spleen</span> <strong>(Option C)</strong></li>\n<li>Berry Aneurysm</li>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> prolapse</li>\n<li>The most common <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> is <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> Disorders</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1yJ5jQGOcpw9tboVDHb51748452179.mp3", "video": ""}, {"text": "A 65-year-old man with a history of working in a dye factory for 30 years presents with flank pain and gross hematuria. Urinalysis confirms the presence of blood, and cytology shows atypical cells. A retrograde urogram was done given in the image below. He was diagnosed with carcinoma of the renal pelvis. Which of the following statements is incorrect regarding the diagnosis?", "options": [{"label": "A", "text": "The radiographic image shows the Goblet sign.", "correct": false}, {"label": "B", "text": "Patients most commonly present with flank pain", "correct": true}, {"label": "C", "text": "CT urography is the investigation of choice for diagnosis", "correct": false}, {"label": "D", "text": "The most common histological type is transitional cell carcinoma", "correct": false}], "correct_answer": "B. Patients most commonly present with flank pain", "question_images": ["https://image.prepladder.com/content/ErRFmnSykMEFzFs6K5VV1740021702.png"], "explanation_images": ["https://image.prepladder.com/content/B0meqZYJKSYMLg7b14xH1740021739.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common: </strong>Transitional Cell Carcinoma<strong> </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smoking (common risk factor causing field defect/field cancerization)</li>\n<li>Analgesics like phenacetin</li>\n<li><strong>Industrial Dye</strong>/ Solvent exposure</li>\n<li>Balkan's Nephropathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>The most common symptom</strong> is painless <span class=\"customMeta\" data-dictid=\"2fb95074611692777188024c7d70a0\">gross hematuria</span> <strong>(Option B)</strong></li>\n<li>Flank pain</li>\n<li>Irritative voiding symptoms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ureteroscopic brush cytology: </strong>Can diagnose tumors at the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis</li>\n<li><strong>IVP: </strong>Filling <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> can be seen</li>\n<li><strong>CT scan: </strong>Enhancing <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> with mild <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defects. Obstructive signs may or may not be present.</li>\n<li><strong>Bergman sign</strong>: Coiling of the <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the obstruction</li>\n<li><strong>Goblet sign:</strong> Dilation of parts of <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> seen on Retrograde pyelography</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Inman, Brant &amp; Blute, Michael &amp; Hartman, R.P..\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/mage-from-a-retrograde-pyelogram-demonstrates-a-TCC-filling-the-distal-right-ureter_fig14_227116811\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/B0meqZYJKSYMLg7b14xH1740021739.png\" width=\"300\"/></p>\n<ul>\n<li><strong>IOC for diagnosis</strong>: CT Urography<strong> </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephroureterectomy + Removal of the <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> of the bladder</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iwGWPDItbUWR0yS5HhaK1748451997.mp3", "video": ""}, {"text": "A 4-year-old girl is brought to the pediatrician with a palpable abdominal mass. Imaging studies reveal a large renal tumor and a biopsy confirms the diagnosis of Wilms tumor. Which of the following statements regarding Wilms tumor is correct?", "options": [{"label": "A", "text": "Chemotherapy is contraindicated in Wilms tumor due to the young age of the patients", "correct": false}, {"label": "B", "text": "The most common site of metastasis in patients with Wilms tumor is the Liver.", "correct": false}, {"label": "C", "text": "A multimodal approach including surgery, chemotherapy, and radiation is typically used.", "correct": true}, {"label": "D", "text": "The route of spread is mostly lymphatic for metastasis of tumor foci.", "correct": false}], "correct_answer": "C. A multimodal approach including surgery, chemotherapy, and radiation is typically used.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triad:</strong></p>\n<ul>\n<li>Asymptomatic <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass <strong>(MC presentation)</strong></li>\n<li>Fever (disappears after tumor resection)</li>\n<li>Hematuria (Gross/Microscopic)</li>\n</ul>\n<p><strong>Rarely</strong>: Pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>USG- </strong>Primary investigation</p>\n<p><strong>CECT-</strong> Investigation of choice.</p>\n<p><strong>MRI - </strong>For better soft tissue visualization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment approach varies based on stage and histology-</p>\n<p><strong>Multimodal approach</strong></p>\n<ul>\n<li><strong>Surgery</strong>: Radical <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> or nephron-sparing surgery</li>\n</ul>\n<ul>\n<li><strong>Chemotherapy</strong>: <strong>VCD <span class=\"customMeta\" data-dictid=\"988bd8e7c71692777197b9f1d5d5ca\">regimen</span> </strong><strong>(Option A)</strong></li>\n</ul>\n<p>Vincristine, Cyclophosphamide, Dactinomycin/Doxorubicin</p>\n<ul>\n<li><strong>Radiation therapy</strong>: For higher stages or unfavorable histology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I.</strong> Disease confined to the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> and completely resectable</p>\n<p><strong>II</strong>. Tumor extends beyond the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> but can be excised completely</p>\n<p><strong>IlI</strong>. <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> disease after <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> with positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and massive spillage</p>\n<p><strong>IV</strong>. Blood-borne metastasis</p>\n<p><strong>V</strong>. <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most important <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">Prognostic</span> Factor - <strong>Histology &gt; Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly through a <strong>hematogenous route </strong>into: <strong>(Option D)</strong></p>\n<ul>\n<li>Lungs (MC)<strong> </strong><strong>(Option B)</strong></li>\n<li>Liver</li>\n<li>Bones (Rarely)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0dakapr3Kc9WCOkZOJKi1748355900.mp3", "video": ""}, {"text": "A 2-year-old male child presents with severe proteinuria, ambiguous genitalia, and hypertension. His karyotype is 46XY, and genetic testing reveals a missense mutation in the WT1 gene. Imaging studies show a unilateral renal mass. Which of the following is the most likely explanation for the patient's clinical presentation?", "options": [{"label": "A", "text": "Beckwith-Wiedemann syndrome with Wilms' tumor", "correct": false}, {"label": "B", "text": "Denys-Drash syndrome with gonadal dysgenesis", "correct": true}, {"label": "C", "text": "Frasier syndrome with gonadoblastoma", "correct": false}, {"label": "D", "text": "Perlman syndrome with nephroblastomatosis", "correct": false}], "correct_answer": "B. Denys-Drash syndrome with gonadal dysgenesis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6PECX9ZHFA8wuJXtdKyB1748355768.mp3", "video": ""}, {"text": "A 55-year-old man presents with painless hematuria and a palpable mass in the left flank. Imaging studies reveal a renal mass measuring 8 cm with evidence of invasion into the renal vein but no involvement of surrounding lymph nodes or distant metastasis. According to the TNM staging system, what is the most appropriate stage of this renal cell carcinoma?", "options": [{"label": "A", "text": "Stage I", "correct": false}, {"label": "B", "text": "Stage II", "correct": false}, {"label": "C", "text": "Stage III", "correct": true}, {"label": "D", "text": "Stage IV", "correct": false}], "correct_answer": "C. Stage III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LDmzDLVKbWJqo56TkwCu1740021561.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Code</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary tumors cannot be assessed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No evidence of a primary tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor ≤7 cm in greatest dimension, limited to the kidney</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤4 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt;4 cm but ≤7 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor &gt;7 cm, limited to the kidney</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt;7 cm but ≤10 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt;10 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The tumor extends into major veins or <span class=\"customMeta\" data-dictid=\"419338f1b71692777195411fd0bfcd\">perinephric</span> tissues but not into the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and not beyond Gerota’s fascia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The tumor extends into the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> or its <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> branches or invades <span class=\"customMeta\" data-dictid=\"07eb540b841692777195078fd4c928\">perirenal</span> and/or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> fat but not beyond Gerota’s fascia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends into the <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> below the diaphragm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3c</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends into the <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> above the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> or invades the wall of the <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor invades beyond Gerota’s <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> (including <span class=\"customMeta\" data-dictid=\"2a2420d6bc1692777185ac0cb7e93d\">contiguous</span> extension into the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> gland)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node(s)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QABDAQvpsh5T8uUC8f9t1746105330.mp3", "video": ""}, {"text": "A 62-year-old woman with a history of smoking presents with a sudden onset of headaches and visual disturbances. A CT scan shows a 5 cm mass in the left kidney. Which of the following is most likely associated with her condition?", "options": [{"label": "A", "text": "Addison's disease", "correct": false}, {"label": "B", "text": "Hypocalcemia", "correct": false}, {"label": "C", "text": "Hypotension", "correct": false}, {"label": "D", "text": "Polycythemia", "correct": true}], "correct_answer": "D. Polycythemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FFn8wLcASNvoO9dFZxid1748355483.mp3", "video": ""}, {"text": "A 65-year-old male presents with an incidental finding of a renal mass on imaging. The mass shows an enhancing appearance on cross-sectional imaging with a central stellate scar. A biopsy is inconclusive, and the mass is surgically removed. Histopathological examination reveals granular, eosinophilic cytoplasm within the tumor cells, negative for cytokeratin 7. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Clear Cell Renal Cell Carcinoma", "correct": false}, {"label": "B", "text": "Renal Oncocytoma", "correct": true}, {"label": "C", "text": "Chromophobe Renal Cell Carcinoma", "correct": false}, {"label": "D", "text": "Papillary Renal Cell Carcinoma", "correct": false}], "correct_answer": "B. Renal Oncocytoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3bo5rg7wJxhuFgd6H1NP1740021439.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Renal Oncocytoma</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition &amp; Prevalence</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Benign <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tumor</strong> with oncocytes, characterized by granular, <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm.</li>\n<li>Accounts for ~5% of all <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tumors.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Typically occurs in the seventh decade of life, more common in males.</li>\n<li>Can coexist with RCC in ~10% of cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>CECT</strong>: (<strong>Investigation of choice): </strong>Presents as an <strong>enhancing mass, </strong>while not pathognomonic, can suggest oncocytoma:\n\t\t\t\t<ul>\n<li><strong>Central <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">Stellate</span> Scarring:</strong> The presence of a star-shaped <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> within the tumor.</li>\n<li><strong>Spoke Wheel Appearance</strong>: A characteristic pattern observed during the angiographic phase of imaging.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Confirmation of Diagnosis</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Confirmed post-surgical removal and histopathological examination of oncocytes.</li>\n<li>Differentiation from <span class=\"customMeta\" data-dictid=\"cbc547b67e169277718420dd29912f\">chromophobe</span> RCC (eosinophilic variant) may require immunohistochemistry, where <span class=\"customMeta\" data-dictid=\"cbc547b67e169277718420dd29912f\">chromophobe</span> RCC stains positive for <strong>cytokeratin 7 </strong>and <span class=\"customMeta\" data-dictid=\"bf5210c5c716927771944a479ea1a2\">oncocytoma</span> is positive.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment &amp; Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Nephron-sparing surgery (<strong>partial nephrectomy</strong>) is the preferred treatment due to its <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> nature.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PlHLtjnqyvES6HqZ3sxH1748355224.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">